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10066149-RR-11 | 10,066,149 | 20,842,875 | RR | 11 | 2137-12-31 04:40:00 | 2137-12-31 06:06:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ man status post motor vehicle collision with
loss of consciousness.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 9.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 1,706 mGy-cm.
COMPARISON: None.
FINDINGS:
There is a complex calvarial fracture. There is a transversely oriented
occipital bone fracture which extends from the right occipital/mastoid suture
through the occipital bone and into the left mastoid. There is also a
parasagittal fracture line through the right occipital bone.
There is a small amount of pneumocephalus within the bilateral posterior fossa
and along the left posterior convexity. There is a small, 3 mm extra-axial
hematoma along the left occipital and posterior temporal lobes, contiguous
with the superior margin of the left transverse sinus, images 303b:156,
303b:171. There may also be up to 3 mm extra-axial hematoma in the left
posterior fossa contiguous with the transverse sinus, image 303b:137, versus
asymmetric appearance of the left sigmoid sinus.
There is no evidence for edema or mass effect in the brain parenchyma. The
ventricles are mildly prominent for age. Cerebellar tonsils are normally
positioned, and ___ cisterna magna is noted.
There is partial opacification of left superior mastoid air cells. Right
mastoid air cells, bilateral middle ear cavities, and bilateral pneumatized
petrous apices appear well-aerated. Allowing for motion artifact, only
minimal mucosal thickening is seen in the ethmoid and maxillary sinuses.
There is periapical lucency ___ 3, image 302b:56.
Concurrent cervical spine CT is reported separately.
IMPRESSION:
1. Complex calvarial fracture, including a transversely oriented occipital
bone fracture extending from the right occipital/mastoid suture through the
occipital bone and into the left mastoid, and a right parasagittal occipital
bone fracture.
2. 3 mm extra-axial hematoma along the left occipital and posterior temporal
lobes, contiguous with the left transverse sinus. Possible additional 3 mm
extra-axial hematoma in the left posterior fossa contiguous with the
transverse sinus, versus asymmetric appearance of the left sigmoid sinus.
3. Partial opacification of left superior mastoid air cells, likely
hemorrhagic given the left mastoid fracture.
4. Periapical lucency ___ 3. Please correlate clinically whether active
dental inflammation may be present.
RECOMMENDATION(S):
1. CT venogram to assess patency of the left transverse sinus.
2. Temporal bone CT for better assessment of left inner ear and middle ear
structures.
NOTIFICATION: The following preliminary report was provided by Dr. ___
___ after the exam (see the wet read section below regarding the
timing of the wet read): "Left temporal bone fracture with small amount of
adjacent pneumocephalus and an extra-axial hematoma measuring up to 3 mm in
greatest thickness, with no significant mass-effect. Right posterior parietal
fracture with small amount of adjacent pneumocephalus." The recommendations
above were discussed with ___, M.D. by ___, M.D. on the
telephone on ___ at 11:23 am.
|
10066149-RR-12 | 10,066,149 | 20,842,875 | RR | 12 | 2137-12-31 04:40:00 | 2137-12-31 05:28:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: History: ___ status post motor vehicle collision with loss of
consciousness. Evaluate for cervical spine injury.
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.7 s, 22.1 cm; CTDIvol = 37.0 mGy (Body) DLP = 818.5
mGy-cm.
2) Spiral Acquisition 5.4 s, 21.3 cm; CTDIvol = 36.9 mGy (Body) DLP = 787.8
mGy-cm.
Total DLP (Body) = 1,606 mGy-cm.
COMPARISON: None.
FINDINGS:
The patient was scanned twice due to motion on the initial scan.
Alignment is normal. No cervical spine fractures are identified. There is no
evidence for prevertebral edema. Small disc protrusions indent the ventral
thecal sac from C3-C4 through C5-C6.
The thyroid and included lung apices are unremarkable.
Complex bilateral occipital and left temporal bone fracture with associated
intracranial abnormalities are better assessed on the concurrent head CT.
IMPRESSION:
No cervical spine fracture or malalignment.
|
10066149-RR-13 | 10,066,149 | 20,842,875 | RR | 13 | 2137-12-31 04:40:00 | 2137-12-31 06:16:00 | INDICATION: History: ___ MVC + LOC// eval for injury
TECHNIQUE: MDCT axial images were acquired through the chest, abdomen and
pelvis following intravenous contrast administration with split bolus
technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 8.9 s, 70.1 cm; CTDIvol = 18.3 mGy (Body) DLP =
1,283.1 mGy-cm.
Total DLP (Body) = 1,283 mGy-cm.
COMPARISON: None.
FINDINGS:
CHEST:HEART AND VASCULATURE: The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma.
PLEURAL SPACES: There is a tiny right pneumothorax (2:32). No pleural
effusion.
LUNGS/AIRWAYS: Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally.
BASE OF NECK: Visualized portions of the base of the neck show no abnormality.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A
subcentimeter hepatic hypodensity is too small to characterize, however likely
represents a hepatic cyst or biliary hamartoma. There is no evidence of
laceration. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
ADRENALS: There is mild thickening of the bilateral adrenal glands without
focal nodule.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. There is no
evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm or retroperitoneal hematoma.
No atherosclerotic disease is noted.
BONES: There is no acute fracture. No focal suspicious osseous abnormality.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Tiny right pneumothorax.
2. No acute trauma in the abdomen or pelvis.
|
10066149-RR-14 | 10,066,149 | 20,842,875 | RR | 14 | 2137-12-31 16:19:00 | 2137-12-31 16:38:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old s/p MVC (+EtOH) w/ minute R apical PTX seen on CT
Chest// please assess for interval change***please perform at 4PM***
TECHNIQUE: Chest two views
COMPARISON: Chest x-ray ___ 04:16, CT chest abdomen pelvis ___ 04:40
FINDINGS:
Better lung aeration since prior, no infiltrates. Normal heart size,
pulmonary vascularity. No edema. No effusion. Probable tiny right apical
pneumothorax.
IMPRESSION:
Probable tiny right apical pneumothorax.
|
10066149-RR-15 | 10,066,149 | 20,842,875 | RR | 15 | 2137-12-31 18:38:00 | 2137-12-31 20:13:00 | EXAMINATION: CT ORBITS, SELLA AND IAC W/ AND W/O CONTRAST
INDICATION: ___ year old man s/p MVC (+EtOH) w/ pneumocephalus w/ temporal
bone fx// please assess left inner ear and middle ear structures
TECHNIQUE: Routine MDCT study of temporal bone was performed with coronal
reconstructions.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.9 s, 12.1 cm; CTDIvol = 123.5 mGy (Head) DLP =
1,490.9 mGy-cm.
Total DLP (Head) = 1,491 mGy-cm.
COMPARISON: CT head without contrast from ___.
FINDINGS:
Left: There is Y shaped vertical fracture of the right paramedian occipital
bone, with 1 oblique segment extension into the left atrium mastoid segment,
extending anteriorly into the anterior margin of the condylar fossa, and very
base of the zygomatic process. Moderate, greater than 50% opacification left
mastoid air cells, opacified mesotympanum, hypotympanum of the middle ear
cavity. Attachment of the increase, articulation of the malleus / incus is
maintained. Fracture plain seems to extend just superolateral to the
articulation between the malleus and incus. Articulation between incus,
stapes is difficult to assess secondary to fluid, it is probably maintained.
Incus is not dislocated from oval window. Clinically correlate to exclude
conductive hearing loss. Fractured does not definitely traverse course of
facial nerve, clinically correlate.
The external auditory canal is normal. There is no evidence for enlarged
vestibular aqueduct or superior semicircular canal dehiscence. There is no
evidence for inner ear dysplasia.
Right: Second segment of the occipital bone fractures extends to the
synchondrosis, does not extend into the temporal bone. There is no fluid in
the mastoids, middle ear. The external auditory canal is normal. The middle
ear cavity is clear. The ossicles are intact. There is no evidence for
enlarged vestibular aqueduct or superior semicircular canal dehiscence. The
facial nerve follows a normal course through the middle ear. There is no
evidence for inner ear dysplasia. The mastoids are clear.
Other: The known hematoma adjacent to torcula and venous sinuses, including
bilateral transverse and superior sagittal sinus, are better seen on the same
day CT Venogram exam. It contains few air bubbles, likely related to
violation of the left temporal bone.
IMPRESSION:
1. Fracture of the occipital bone, longitudinal fractures of the left temporal
bone. No fractures of the right temple bone.
2. Opacified left mastoids, middle ear cavity.
3. The known extra-axial hematoma about torcula and venous sinuses are better
seen on the same-day CT venogram exam.
|
10066149-RR-16 | 10,066,149 | 20,842,875 | RR | 16 | 2137-12-31 18:39:00 | 2137-12-31 19:41:00 | EXAMINATION: CTA HEAD WANDW/O C AND RECONS Q1213 CT HEAD
INDICATION: ___ year old man s/p MVC (+EtOH) w/ pneumocephalus w/ temporal
bone fx// per prior CT head report, please perform CT venogram to assess
patency of the left transverse sinus
TECHNIQUE: Contiguous axial images of the brain were obtained before and
after the intravenous administration of 70 mL of Omnipaque contrast agent.
Thin bone-algorithm reconstructed images and coronal and sagittal reformatted
images were then produced.
DOSE: Total DLP: 1572 mGy-cm
COMPARISON: CT head without from ___.
FINDINGS:
Mild left scalp soft tissue swelling is more prominent. There is vertical
right paramedian occipital bone fracture, extension through the suture into
the left side into left temporal bone, with partial opacification of the left
mastoid air cells, middle ear cavity. Tiny bone fragment extends 1 mm
intracranially along the fractured plane series 3, image 97. No calvarial
depression.
There is extra-axial acute hematoma measuring 0.5 cm overlying posterior
margin of the superior sagittal sinus extending 3 cm above torcula, along the
posterior margin of bilateral medial ___ of transverse sinuses. There are
few air locule is within the hematoma. Hematoma size is stable compared with
head CT ___ 04:40. Left transverse sinus is hypoplastic. There is
moderate/severe narrowing of the adjacent superior sagittal sinus, medial
right and medial left transverse sinuses, without sinus occlusion. Distal
transverse, sigmoid sinuses and upper jugular veins are patent, with dominant
right side. Visualized arterial system is within normal limits.
There is no abnormal enhancement on post contrast images.
Minimal mucosal thickening is seen in the right maxillary sinus. Otherwise,
the remaining visualized portion of the paranasal sinuses, mastoid air cells,
and middle ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. Extra-axial hematoma along the posterior margin of the superior sagittal,
and medial bilateral transverse sinuses causing moderate to severe narrowing
of sinuses, without occlusion few air locule is within the sinus, likely
related to left temporal bone fractures. No change in the size of hematoma.
Consider venous sinus injury as source of hemorrhage, close imaging follow-up
recommended.
2. Stable acute occipital bone, left temporal bone fractures.
|
10066149-RR-17 | 10,066,149 | 20,842,875 | RR | 17 | 2138-01-01 11:56:00 | 2138-01-01 12:46:00 | INDICATION: ___ year old man with acute-on-chronic L knee pain s/p MVC//
please eval for interval change
COMPARISON: None here at this institution.
IMPRESSION:
There is hardware within the proximal tibia. No hardware related
complications are seen. Comminuted fracture of the proximal tibia with
extension to the knee joint is seen. There is mild lateral compartmental
joint space narrowing. There is a large knee joint effusion. External
fixation pin tracts are seen in the femur and tibia.
|
10066209-RR-10 | 10,066,209 | 27,826,282 | RR | 10 | 2121-07-05 03:49:00 | 2121-07-05 08:29:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with COPD, here w/ respiratory failure;
intubated // eval ETT eval ETT
IMPRESSION:
Comparison to ___. The endotracheal tube has been slightly pulled
back and the tip of the tube now projects 3 cm above the carina. Mild
pulmonary edema. Elevation of the right hemidiaphragm with subsequent right
basilar atelectasis. Moderate cardiomegaly persists.
|
10066209-RR-11 | 10,066,209 | 27,826,282 | RR | 11 | 2121-07-06 05:03:00 | 2121-07-06 11:13:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with septic shock, intubated // please eval
ETT placement please eval ETT placement
IMPRESSION:
Compared to prior chest radiographs ___ through ___.
Patient has been extubated, but low lung volumes have improved although there
is still substantial bibasilar atelectasis. Heart size top-normal. Pulmonary
vascular congestion is exaggerated by the low lung volumes. There is no
pulmonary edema. Pleural effusions small if any. No pneumothorax.
|
10066209-RR-12 | 10,066,209 | 27,826,282 | RR | 12 | 2121-07-06 10:42:00 | 2121-07-06 15:11:00 | INDICATION: ___ year old woman with PMS of recurrent TIA, COPD, ischemic
colitis who was admitted to the FICU for history of hypotension, sepsis //
evaluate for dilated bowel
TECHNIQUE: Portable supine abdominal radiograph was obtained.
COMPARISON: CT abdomen and pelvis with contrast from ___
FINDINGS:
There is prominence of bowel gas in the ascending colon. There are no
abnormally dilated small bowel or large bowel loops.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
There is severe degenerative changes of the lumbar spine with scoliosis.
There are no unexplained soft tissue calcifications. A left femoral central
line is incidentally noted.
IMPRESSION:
Mild prominence of bowel gas in the ascending colon. No evidence of
obstruction or perforation.
|
10066209-RR-13 | 10,066,209 | 27,826,282 | RR | 13 | 2121-07-07 04:46:00 | 2121-07-07 14:03:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with PMS of recurrent TIA, COPD, ischemic
colitis who was admitted to the FICU for history of hypotension, sepsis //
evaluate for edema and consolidation evaluate for edema and consolidation
IMPRESSION:
Compared to chest radiographs ___ through ___ at 05:24.
Lower lung volumes exaggerates the severity of new pulmonary edema. Moderate
cardiomegaly is stable but pulmonary vasculature and mediastinal veins are
more dilated. Pleural effusion is likely but not large. No pneumothorax.
|
10066209-RR-5 | 10,066,209 | 27,826,282 | RR | 5 | 2121-07-04 01:13:00 | 2121-07-04 02:58:00 | EXAMINATION: CT ABD AND PELVIS WITH CONTRAST
INDICATION: ___ with hypothermia and abdominal pain, found to have
leukocytosis. Evaluate for infection.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique. IV Contrast: 130 mL Omnipaque.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: Total DLP: 994 mGy-cm
COMPARISON: None.
FINDINGS:
LOWER CHEST: Evaluation of the lung bases is slightly limited by motion.
However, there is likely subsegmental atelectasis bilaterally. No pleural
effusion. Heart size is normal, and there is no pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: Right adrenal gland appears diffusely thickened, with no evidence of
a focal nodule. Left adrenal gland is unremarkable.
URINARY: Right kidney is normal in size with normal nephrogram. Left kidney
is severely atrophic. There is a 7 mm hypodensity in the interpolar region of
the right kidney, and several sub-cm hypodensities in the left kidney, which
are too small to characterize. No hydronephrosis. There is no perinephric
abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. There is wall
thickening and pericolonic fat stranding involving nearly the entire colon,
compatible with pancolitis, although the cecum appears to be spared. These
findings are most pronounced in the descending and sigmoid colon. Scattered
diverticuli are noted. Rectum is unremarkable in appearance. Appendix is not
identified, but there are no secondary signs of acute appendicitis. There is
no free air.
PELVIS: Urinary bladder is largely collapsed around a Foley catheter. A
locule of post instrumentation intraluminal air is noted. Trace free fluid is
noted in the pelvis (2a:79).
REPRODUCTIVE ORGANS: Uterus and ovaries are not definitely identified.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
BONES: Severe multilevel degenerative changes are noted throughout the
thoracolumbar spine. There is approximately 50% loss of height at T11, age
indeterminate.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Near pancolitis with relative sparing of the cecum, most likely infectious
or inflammatory.
2. Approximately 50% loss of height at T11, chronicity indeterminate.
3. Note that the left kidney is atrophic.
|
10066209-RR-6 | 10,066,209 | 27,826,282 | RR | 6 | 2121-07-04 01:37:00 | 2121-07-04 06:15:00 | EXAMINATION: CHEST (SINGLE VIEW)
INDICATION: ___ female septic and hypotensive, found to have
pancolitis on CT abdomen. Evaluate for pneumonia.
TECHNIQUE: AP upright and erect images were obtained
COMPARISON: CT abdomen/pelvis ___
FINDINGS:
There is an opacity at the right lung base, which is at least partially due to
the elevated right hemidiaphragm and high positioning of the liver as seen on
the concurrent CT abdomen. Right pleural effusion is small. Bibasilar
atelectasis is present. . There is no pneumothorax. Heart size is normal.
IMPRESSION:
Bibasilar atelectasis. Marked elevation right hemidiaphragm and small right
pleural effusion.
|
10066209-RR-7 | 10,066,209 | 27,826,282 | RR | 7 | 2121-07-04 09:21:00 | 2121-07-04 09:49:00 | EXAMINATION: Portable chest radiograph
INDICATION: ___ year old woman with respiratory failure and pneumonia, now
intubated // Eval ETT
IMPRESSION:
In comparison to prior radiograph from earlier today, the patient has been
intubated with endotracheal tube malpositioned within the right main bronchus
near the junction with the bronchus intermedius. Exam is otherwise remarkable
for worsening atelectasis in the left mid and lower lung and slight improved
aeration at the right lung base.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 9:44 AM, 5 minutes after discovery of
the findings.
|
10066209-RR-8 | 10,066,209 | 27,826,282 | RR | 8 | 2121-07-04 09:48:00 | 2121-07-04 11:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with new EET, pulled back 3cm // Eval position
of ETT
IMPRESSION:
Since the prior radiograph from approximately 30 min earlier, an endotracheal
tube has been repositioned, with tip now terminating in the proximal right
main bronchus. No other relevant change.
NOTIFICATION: The findings were discussed with ___, M.D. by ___,
M.D. on the telephone on ___ at 11:41 AM, 5 minutes after discovery of
the findings.
|
10066209-RR-9 | 10,066,209 | 27,826,282 | RR | 9 | 2121-07-04 10:26:00 | 2121-07-04 11:45:00 | EXAMINATION: Semi-erect portable chest radiograph
INDICATION: ___ year old woman with new ETT, pulled back 3cm // Eval position
of ETT
TECHNIQUE: Semi-erect portable chest radiograph
COMPARISON: Radiograph from ___ at 10:00
FINDINGS:
Compared to radiograph taken 47 minutes prior, the endotracheal tube has been
pulled back to approximately 2.3 cm from the carina. Otherwise, there is no
relevant change. Enteric tube courses below the diaphragm and out of view.
IMPRESSION:
ETT terminates approximately 2.3 cm from the carina. No other relevant
change.
|
10066489-RR-31 | 10,066,489 | 26,697,349 | RR | 31 | 2141-07-28 14:36:00 | 2141-07-28 17:29:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with history of subdural hematoma s/p
craniotomy ___ presents from rehab with abd pain/constipation, now altered
with no focal neuro changes // interval change
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Stationary
Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP = 684.4 mGy-cm.
Total DLP (Head) = 684 mGy-cm.
COMPARISON: Comparison is made with prior head CT from ___.
FINDINGS:
Patient is status post left frontal craniotomy with interval subdural drain
removal. Known left subdural hematoma appears stable in comparison to prior
imaging from ___ and measures 11 mm at its maximum dimension,
previously measured at 13 mm. The rightward midline shift is improved from
previously measured 10 mm to 6 mm on current exam. There is continued sulcal
effacement and local mass effect, which remains stable compared to previous
exam. Pneumocephalus appears slightly improved. No evidence of new hemorrhage
or infarction.
Decreased compression of the left lateral ventricle. Right lateral ventricle
appears stable compared to prior exam.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Prior nasal
bone fracture is seen (series 5, image 8.) Sutures are visualized overlying
the soft tissues of the left frontotemporal and temporoparietal regions.
Patient status post bilateral lens replacements.
IMPRESSION:
1. Interval subdural drain removal with stable subdural hematoma when compared
to prior imaging with improvement in associated pneumocephalus.
2. Interval improvement of rightward shift of midline structures with
decreased compression of the left lateral ventricle.
3. No new hemorrhages or infarcts.
|
10066737-RR-15 | 10,066,737 | 20,634,740 | RR | 15 | 2162-06-14 02:04:00 | 2162-06-14 05:16:00 | EXAMINATION: MR CERVICAL SPINE W/O CONTRAST
INDICATION: History: ___ with C-spine fractures // assess for ligamentous,
cord, and vascular injuries
TECHNIQUE: MRI of the cervical spine was performed without contrast.
COMPARISON: No prior MRI available. Prior CT scan from earlier same date.
FINDINGS:
Fractures of the C5 left lateral mass, left lamina, left inferior articular
process, left C5-C6 facet joint, C6 vertebral body, C6 left lateral mass, C6
left articular pillar, and C6 left transverse process are better visualized on
the previously performed CT scan. There is prevertebral fluid extending from
C5 through C7 greatest at C6. The anterior longitudinal ligament cannot be
well visualized at this level and therefore tear cannot be excluded. The
posterior longitudinal ligament appears intact. There is focal discontinuity
of the ligamentum flavum at C5-C6 suspicious for tear. There is also increased
signal noted in the interspinous ligaments at C4-C5 and C5-C6.
On the sagittal images, there is mild C3 on C4 and C5 on C6 anterolisthesis
unchanged. No suspect marrow lesions are seen. There is diffuse mild loss of
normal intervertebral disc signal. There is loss of normal intervertebral disc
height at C5-C6 and C6-C7.
At C2-C3, there is no significant herniation, spinal canal stenosis, or neural
foraminal narrowing.
At C3-C4, there is no significant disc herniation or spinal canal stenosis.
There is mild bilateral uncovertebral joint facet joint arthropathy resulting
in mild right greater than left neural foraminal narrowing.
At C4-C5, there is diffuse disc bulge with a tiny superimposed central disc
protrusion without significant spinal canal stenosis. There is mild bilateral
facet and uncovertebral joint arthropathy resulting in mild bilateral neural
foraminal narrowing.
At C5-C6, there is diffuse disc bulge with a superimposed central disc
protrusion resulting in mild to moderate spinal canal stenosis. There is mild
bilateral uncovertebral joint facet joint arthropathy resulting in mild neural
foraminal stenosis.
At C6-C7, there is diffuse disc bulge with a tiny central superimposed disk
protrusion resulting in mild spinal canal stenosis. There is bilateral
uncovertebral facet joint osteophytes resulting in a mi to right and moderate
left neural foraminal narrowing.
At C7-T1, there is no disk herniation or spinal canal stenosis. There is left
facet arthropathy resulting in mild left neural foraminal narrowing.
The craniovertebral junction is unremarkable. The cord is normal in morphology
and signal intensity.
The visualized soft tissues of the neck are unremarkable.
IMPRESSION:
Fractures of the C5 and C6 vertebral are better demonstrated on prior CT scan.
Prevertebral fluid is seen from C5 through C6. There is injury of the
interspinous ligaments at C4-C5 and C5-C6 and focal disruption of the
ligamentum flavum at C5-C6. The anterior longitudinal ligament cannot be well
visualized at these levels secondary to prevertebral fluid and tear cannot be
excluded.
Multilevel degenerative changes as detailed above which are most severe at
C5-C6 and C6-C7. There is no abnormal cord signal.
|
10066737-RR-16 | 10,066,737 | 20,634,740 | RR | 16 | 2162-06-14 03:29:00 | 2162-06-14 06:05:00 | EXAMINATION: MRA NECK W/O CONTRAST
INDICATION: The cervical fractures assess for vascular injury.
TECHNIQUE: A 2D time-of-flight MRA of the neck was performed without contrast
tear
COMPARISON: none
FINDINGS:
MRA neck: The common, internal and external carotid arteries appear normal.
There is no evidence of stenosis by NASCET criteria. The origins of the great
vessels, subclavian and vertebral arteries appear normal bilaterally.
IMPRESSION:
Normal Study
|
10067195-RR-4 | 10,067,195 | 21,564,201 | RR | 4 | 2181-08-27 04:09:00 | 2181-08-27 05:34:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: eval portal vein thrombosis
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: None.
FINDINGS:
Liver: The hepatic parenchyma demonstrates a few ill-defined predominantly
hypoechoic to isoechoic lesions, incompletely characterized on this exam.
There is an additional 1.2 x 1.0 x 1.3 cm hyperechoic lesion in the right
hepatic lobe, which is also nonspecific. There is a trace amount of ascites.
Bile ducts: There is moderate intrahepatic biliary ductal dilation. The
common bile duct is enlarged and measures 1.5 cm.
Gallbladder: Sludge is demonstrated in the gallbladder without evidence of
acute cholecystitis.
Pancreas: An isoechoic nodule about the pancreas suggests a peripancreatic
lymph node measuring 1.5 x 2.0 x 1.7 cm. The remaining portions of the
pancreas appear grossly normal. The main pancreatic duct is dilated,
measuring up to 5 mm.
Spleen: The spleen demonstrates normal echotexture, and measures 11.9 cm.
Kidneys: The right kidney measures 10.7 cm. The left kidney measures 9.3 cm.
No stones, masses, or hydronephrosis are identified in either kidney.
Limited doppler evaluation of the portal system:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 37.5 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The SMV, splenic, and arterial vasculature are not evaluated.
IMPRESSION:
1. Patent portal vasculature. Please note that the SMV, splenic, and arterial
vasculature are not evaluated with this technique.
2. Enlarged peripancreatic lymph node.
3. A few ill-defined iso-to-hypoechoic hepatic lesions and one discrete
hyperechoic lesion are incompletely characterized, but concerning for
metastatic disease, not optimally evaluated with this technique.
4. Sludge is demonstrated in the gallbladder. No evidence of acute
cholecystitis.
RECOMMENDATION(S): Multiphasic Liver CTA or MRI can be obtained for further
evaluation of liver and other findings.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 9:30 am, 10 minutes after
discussion with attending radiologist.
|
10067821-RR-26 | 10,067,821 | 25,685,371 | RR | 26 | 2165-10-31 16:15:00 | 2165-10-31 19:16:00 | INDICATION: History of diverticulitis and hepatitis C with two days of
clinical diverticulitis.
No comparison studies available.
TECHNIQUE:
MDCT-acquired 5-mm axial images of the abdomen and pelvis were obtained
following the uneventful administration of oral contrast and 130 mL of
Omnipaque intravenous contrast. Coronal and sagittal reformations were
performed at 5-mm slice thickness.
Examination DLP 674 mGy-cm.
CT OF THE ABDOMEN WITH IV CONTRAST:
Included views of the lung bases demonstrate mild dependent atelectasis.
There is no pericardial or pleural effusion. The heart size is normal.
There is mild hepatic steatosis. A focus of hyperenhancement within segment V
(2:25), likely represents a benign perfusion shunt. There is cholelithiasis,
with no evidence of cholecystitis (2:27). The pancreas, adrenal glands,
kidneys, spleen, stomach, and intra-abdominal loops of small bowel are normal.
There is no mesenteric or retroperitoneal lymphadenopathy, and no free air.
CT OF THE PELVIS WITH IV CONTRAST:
Mild colonic diverticulosis is present. An ill-defined 4.3 x 2.4 cm focus of
fluid, stranding and a tiny amount of gas (2:55) abutting the distal
descending colon is compatible with diverticulitis with microperforation. No
abscess or drainable fluid collections are identified. There is no
intrapelvic free fluid. The rectum, ureters, adnexa, and urinary bladder are
normal. The appendix is not well visualized, but no secondary signs of
appendicitis are detected. There is no intrapelvic lymphadenopathy.
OSSEOUS STRUCTURES: There is no acute fracture. There are no bony lesions
concerning for malignancy or infection.
IMPRESSION: Uncomplicated distal descending colonic diverticulitis. No
drainable fluid collections identified.
The initial findings were communicated by Dr. ___ to Dr. ___ telephone
at the time of interpretation, 6:45 p.m. on ___.
|
10067859-RR-16 | 10,067,859 | 23,598,978 | RR | 16 | 2113-03-07 09:54:00 | 2113-03-07 10:11:00 | EXAMINATION: FEMORAL VASCULAR US LEFT
INDICATION: ___ year old man s/p EVAR for symptomatic/dissected infrarenal
AAA// eval for L groin pseudoaneurysm
TECHNIQUE: Grayscale, color, and spectral Doppler evaluation of the left
groin.
COMPARISON: None.
FINDINGS:
Normal color flow and spectral Doppler waveforms are present in the common
femoral artery and vein. There is no evidence of hematoma, pseudoaneurysm, or
arteriovenous fistula.
IMPRESSION:
Normal sonographic appearance of the groin, without evidence of hematoma,
pseudoaneurysm, or AV fistula.
|
10068304-RR-82 | 10,068,304 | 23,499,122 | RR | 82 | 2149-07-04 14:04:00 | 2149-07-04 16:54:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with h/o recent vavle/heart surgery and more
recent bleed; now w incr dyspnea/cough eval for evid of congestion
/aspiration or pul etiology to cough // ___ year old woman with h/o recent
vavle/heart surgery and more recent bleed; now w incr dyspnea/cough eval for
evid of congestion /aspiration or pul etiology to cough
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph dated ___.
FINDINGS:
The sternotomy wires appear intact and appropriately aligned.
There are small bilateral pleural effusions with bibasilar atelectasis, worse
on the left. Mild interstitial pulmonary edema. The lungs are otherwise
clear. Heart size is stable. The mediastinal and hilar contours are stable.
No pneumothorax is seen. There are no acute osseous abnormalities.
IMPRESSION:
1. Small bilateral pleural effusions with bibasilar atelectasis.
2. Mild interstitial pulmonary edema.
|
10068304-RR-83 | 10,068,304 | 23,499,122 | RR | 83 | 2149-07-09 08:38:00 | 2149-07-09 12:02:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with CHF, with intermittent dyspnea //
Evaluate for edema, infection
TECHNIQUE: CHEST (PORTABLE AP)
COMPARISON: ___
IMPRESSION:
Heart size and mediastinum are stable including cardiomegaly. Mild vascular
enlargement is demonstrated but no overt pulmonary edema is seen. Bilateral
pleural effusions are most likely present, small to moderate
Old first rib fracture is re- demonstrated on the left
|
10068304-RR-84 | 10,068,304 | 23,499,122 | RR | 84 | 2149-07-11 06:23:00 | 2149-07-11 09:07:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with worsening dyspnea // worsening pulmonary
edema? worsening pulmonary edema?
IMPRESSION:
In comparison with the study of ___, there is continued enlargement of
the cardiac silhouette with only minimal elevation of pulmonary venous
pressure that is unchanged from previous studies. No acute focal pneumonia.
|
10068741-RR-32 | 10,068,741 | 22,137,833 | RR | 32 | 2155-12-29 08:13:00 | 2155-12-29 10:54:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with AoC dCHF // Eval for interval change
Eval for interval change
IMPRESSION:
In comparison with the study of ___, the right heart border is now
sharp. New there is huge enlargement of the cardiac silhouette without
appreciable vascular congestion. This discordance raises the possibility of
cardiomyopathy or pericardial effusion.
|
10068741-RR-33 | 10,068,741 | 22,137,833 | RR | 33 | 2155-12-29 10:08:00 | 2155-12-29 11:48:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old ___ woman with ___ admitted with exacerbation,
elevated LFTs and hepatomegaly on exam // Eval for liver pathology
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. Flow within the main portal vein is noted to be
hyperdynamic which can be seen in the setting of CHF. There is a scant trace
of ascites in the abdomen. Small bilateral pleural effusions are also noted.
BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 7 mm.
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity, measuring 4.8 cm.
KIDNEYS: The right kidney measures 9.0 cm. The left kidney measures 9.8 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses or hydronephrosis in the kidneys.
A small nonobstructing stone measuring 5 mm is incidentally noted in the right
kidney.
RETROPERITONEUM: The aorta is heavily calcified however no aneurysm is
visualized. The visualized portion of the IVC is within normal limits.
IMPRESSION:
1. No focal liver lesion identified. Hepatopetal flow in the main portal vein
which is noted to be hyperdynamic which can be seen in the setting of CHF.
2. Small bilateral pleural effusions and scant trace of ascites in the
abdomen.
3. Small nonobstructing stone incidentally noted in the right kidney.
|
10069692-RR-10 | 10,069,692 | 25,846,597 | RR | 10 | 2148-05-27 10:37:00 | 2148-05-27 12:02:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with s/p fall untwitnessed fall, not fully able to
provide history and right hip pain// head ct: ICH? c-spine: fracture?
hip x-ray: fracture?
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.4 cm; CTDIvol = 48.9 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
Small scalp hematoma overlying the left parieto-occipital calvarium. No
evidence of underlying fracture.
There is no evidence of acute territorial infarction,hemorrhage,edema, or
mass. Findings consistent with mild chronic small vessel ischemic changes.
Generalized brain parenchymal atrophy. Few prominent benign perivascular
spaces. Chronic lacunar infarct right caudate head.
Polypoid mucosal thickening within a left anterior ethmoid air cell.
Otherwise, the visualized portion of the paranasal sinuses, mastoid air cells,
and middle ear cavities are clear. The patient is status post bilateral lens
resections with multiple punctate intra-ocular calcifications bilaterally.
Drusen deposits are seen on the right (series 3, image 19).
IMPRESSION:
1. Mild scalp soft tissue swelling left parieto-occipital calvarium.
2. Brain parenchymal atrophy. Moderate chronic microvascular ischemic
changes.
3. Chronic lacunar infarct right caudate head.
|
10069692-RR-11 | 10,069,692 | 25,846,597 | RR | 11 | 2148-05-27 11:02:00 | 2148-05-27 12:33:00 | EXAMINATION: HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) RIGHT
INDICATION: History: ___ with s/p fall untwitnessed fall, not fully able to
provide history and right hip pain// head ct: ICH? c-spine: fracture?
hip x-ray: fracture?
TECHNIQUE: Frontal view radiograph of the pelvis with additional frontal and
frog-leg lateral views of the right hip.
COMPARISON: None available.
FINDINGS:
There is a complete transcervical fracture through the right femoral neck.
There is overriding and mild varus angulation. There is no evidence of
femoroacetabular dislocation. No other fractures or dislocations are
visualized. There are moderate degenerative changes within the hip joints
bilaterally. There are severe degenerative changes within the partially
imaged lower lumbar spine. The bones are diffusely demineralized. No
suspicious osseous lesions are visualized. Vascular calcifications are noted.
IMPRESSION:
Complete transcervical fracture through the right femoral neck with mild
overriding and varus angulation. No hip dislocation.
|
10069692-RR-12 | 10,069,692 | 25,846,597 | RR | 12 | 2148-05-27 10:37:00 | 2148-05-27 12:14:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311
INDICATION: History: ___ with s/p fall untwitnessed fall, not fully able to
provide history and right hip pain// head ct: ICH? c-spine: fracture?
hip x-ray: fracture? head ct: ICH? c-spine: fracture? hip x-ray:
fracture?
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.5 s, 21.8 cm; CTDIvol = 22.7 mGy (Body) DLP = 494.4
mGy-cm.
Total DLP (Body) = 494 mGy-cm.
COMPARISON: None.
FINDINGS:
Minimal anterolisthesis C3 on C4, C4 on C5, C6 on C7, C7 on T1, T1 on T2,
likely degenerative. No prevertebral edema. No facet joint destruction. No
fractures are identified.There is no prevertebral soft tissue swelling. There
is no evidence of infection or neoplasm.
Multilevel degenerative changes, disc osteophyte complexes, disc space
narrowing, posterior element hypertrophic changes. There is multilevel
probably mild central canal narrowing. Multilevel moderate to severe
foraminal narrowing, worse on the right.
Pleuroparenchymal scarring within the bilateral lung apices. Calcified
granuloma on the left. 3 mm spiculated nodule within the right upper lobe
(series 3, image 63). No cervical lymphadenopathy. Numerous nodules within
the thyroid bilaterally, some of which are calcified. The largest thyroid
nodule measures approximately 1.5 cm on the right.
IMPRESSION:
1. Multilevel minimal anterolisthesis, likely degenerative.
2. No fracture or prevertebral soft tissue swelling.
3. Degenerative changes as above
4. 3 mm lung nodule within the right upper lobe, recommendations below.
5. Numerous thyroid nodules measuring up to 1.5 cm. Thyroid ultrasound can be
considered.
RECOMMENDATION(S): For incidentally detected single solid pulmonary nodule
smaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and
an optional CT in 12 months is recommended in a high-risk patient.
See the ___ ___ Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
___
Thyroid nodule.
___ College of Radiology guidelines recommend further evaluation for
incidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5
cm in patients age ___ or older, or with suspicious findings.
Suspicious findings include: Abnormal lymph nodes (those displaying
enlargement, calcification, cystic components and/or increased enhancement) or
invasion of local tissues by the thyroid nodule.
___, et al, "Managing Incidental Thyroid Nodules Detected on Imaging: White
Paper of the ACR Incidental Findings Committee". J ___ ___
12:143-150.
|
10069692-RR-13 | 10,069,692 | 25,846,597 | RR | 13 | 2148-05-27 12:14:00 | 2148-05-27 13:09:00 | EXAMINATION: Right femur radiographs
INDICATION: History: ___ with right hip fracture, ortho requesting full
length femur// ?fracture
TECHNIQUE: AP and lateral views of the right femur.
COMPARISON: Right hip radiographs with the same date.
FINDINGS:
There is a complete transcervical fracture of the right femoral neck with
overriding and mild varus angulation. There is no hip dislocation. No other
fractures or dislocations are visualized. Degenerative changes within the
right hip joint. Limited views of the right knee are unremarkable. No
suspicious osseous lesions. Extensive vascular calcifications.
IMPRESSION:
Complete transcervical fracture of the right femoral neck with overriding and
mild varus angulation. No other fractures or dislocations visualized.
|
10069692-RR-14 | 10,069,692 | 25,846,597 | RR | 14 | 2148-05-27 12:29:00 | 2148-05-27 14:15:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with pre-operative for right hip pain// ?pneumonia
TECHNIQUE: Single AP radiograph of the chest.
COMPARISON: None available.
FINDINGS:
Hyperinflated lungs. No focal consolidations. No pulmonary edema.
Calcifications of the aortic knob. Otherwise normal size of the
cardiomediastinal silhouette. No pleural effusion. No pneumothorax. Bones
are diffusely demineralized, however no acute osseous abnormalities are
visualized.
IMPRESSION:
Hyperinflated but clear lungs.
|
10069692-RR-15 | 10,069,692 | 25,846,597 | RR | 15 | 2148-05-28 13:03:00 | 2148-05-28 13:57:00 | EXAMINATION: HIP UNILAT MIN 2 VIEWS RIGHT
INDICATION: ___ year old woman with right partial hip replacement// post op
xray
IMPRESSION:
Images from the operating suite show placement of right hip arthroplasty,
which appears well seated with standard postsurgical changes in soft tissues.
Further information can be gathered from the operative report.
|
10069871-RR-10 | 10,069,871 | 26,257,265 | RR | 10 | 2148-06-21 12:07:00 | 2148-06-21 12:21:00 | EXAMINATION: Chest radiograph
INDICATION: History: ___ with chest pain, shortness of breath, syncope//
Pneumonia, Cardiomegaly
TECHNIQUE: Chest PA and lateral
COMPARISON: None
FINDINGS:
The lungs appear clear without focal consolidation. There is no pulmonary
edema, pneumothorax, or pleural effusion. The cardiomediastinal silhouette
and hilar contours are normal.
IMPRESSION:
No acute cardiopulmonary process
|
10069871-RR-11 | 10,069,871 | 26,257,265 | RR | 11 | 2148-06-21 11:26:00 | 2148-06-21 12:08:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with fall, syncope, history of endocarditis//
Fracture or mass in the brain
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.4 cm; CTDIvol = 48.9 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 2.0 s, 4.1 cm; CTDIvol = 48.9 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute major vascular territory
infarction,hemorrhage,edema, or mass effect. The ventricles and sulci are
normal in size and configuration.
There is no evidence of fracture. Tiny retention cyst is seen in the right
sphenoid sinus. Otherwise, the remaining visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable. Incidental note is made of a
calcified soft tissue lesion along the anterior midline scalp, measuring
approximately 1.1 cm, compatible with a sebaceous cyst.
IMPRESSION:
1. No acute intracranial abnormalities on noncontrast head CT. Specifically
no large territory infarct or intracranial hemorrhage.
2. No acute displaced calvarial fracture.
|
10069871-RR-12 | 10,069,871 | 26,257,265 | RR | 12 | 2148-06-21 11:27:00 | 2148-06-21 12:00:00 | EXAMINATION: CT C-SPINE W/O CONTRAST Q311 CT SPINE
INDICATION: History: ___ with fall, syncope, history of endocarditis//
Fracture or mass in the brain Fracture or mass in the brain
TECHNIQUE: Non-contrast helical multidetector CT was performed. Soft tissue
and bone algorithm images were generated. Coronal and sagittal reformations
were then constructed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.4 s, 21.3 cm; CTDIvol = 22.6 mGy (Body) DLP = 480.8
mGy-cm.
Total DLP (Body) = 481 mGy-cm.
COMPARISON: None.
FINDINGS:
Alignment is anatomic.No fractures are identified. There is no evidence of
spinal canal or neural foraminal stenosis. There is no prevertebral soft
tissue swelling. The thyroid gland is unremarkable. The lung apices appear
clear. There are bilateral prominent supraclavicular lymph nodes measuring up
to 1 cm in short axis. On the right, there appears to be mild inflammatory
soft tissue fatty stranding within the supraclavicular region (series 3, image
57). Clinical correlation is recommended.
IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Prominent supraclavicular lymph nodes bilaterally with associated mild
inflammatory fatty stranding on the right. This could be related to the
patient's ongoing endocarditis, however clinical correlation is recommended.
Repeat examination to document resolution following appropriate treatment is
also recommended.
NOTIFICATION: The additional findings detailed in impression 2 was discussed
with Dr. ___. by ___, M.D. on the telephone on ___
at 3:38 pm, 10 minutes after discovery of the findings.
|
10069871-RR-13 | 10,069,871 | 26,257,265 | RR | 13 | 2148-06-21 15:25:00 | 2148-06-21 16:24:00 | EXAMINATION: CTA CHEST WITH CONTRAST
INDICATION: History: ___ with chest pain, shortness of breath,pleuritic //
Septic Emboli, Pulmonary Embolism
TECHNIQUE: Axial multidetector CT images were obtained through the thorax
after the uneventful administration of intravenous contrast. Reformatted
coronal, sagittal, thin slice axial images, and oblique maximal intensity
projection images were submitted to PACS and reviewed.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 1.5 mGy (Body) DLP = 0.8
mGy-cm.
2) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 6.1 mGy (Body) DLP = 3.0
mGy-cm.
3) Spiral Acquisition 2.8 s, 22.3 cm; CTDIvol = 12.5 mGy (Body) DLP = 279.7
mGy-cm.
Total DLP (Body) = 283 mGy-cm.
COMPARISON: Chest radiograph from ___
FINDINGS:
HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. Patient is status post tricuspid valve replacement. The
right atrium appears mildly enlarged. The great vessels are within normal
limits. No pericardial effusion is seen.
AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
PLEURAL SPACES: No pleural effusion or pneumothorax.
LUNGS/AIRWAYS: Several foci of peripheral parenchymal opacities are noted in
the right lower lobe and left lower lobe, which are nonspecific but may be of
infectious or inflammatory etiology. Given recent history of endocarditis,
septic emboli cannot be excluded. There is a small lucent focus adjacent to
the right lower lobe rounded consolidation (3:98). The right lower lobe area
of opacity in totality measures roughly 20 x 9 mm. Additional nodule in the
right lung base measures 3 mm. At the lateral left lung base density measures
12 mm. In the left lung base anteriorly, a nodular density measures 15 mm.
There is a 3 mm subpleural nodule in the right lung apex (3:8). The airways
are patent to the level of the segmental bronchi bilaterally.
ABDOMEN: Included portion of the upper abdomen is unremarkable.
BONES: No suspicious osseous abnormality is seen.? There is no acute fracture.
There is a defect of the lateral right fourth rib, likely postsurgical.
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic abnormality.
2. Several foci of peripheral parenchymal opacities are noted in the right
lower lobe and left lower lobe, with subtle lucent focus adjacent to the right
lower lobe consolidation, which may represent early cavitation and given
recent history of endocarditis, favor septic emboli, though nonspecific
infectious or inflammatory conditions remain differential possibilities.
3. Patient is status post tricuspid valve replacement.
|
10070011-RR-31 | 10,070,011 | 29,479,314 | RR | 31 | 2177-05-18 13:34:00 | 2177-05-18 15:12:00 | INDICATION: Dyspnea.
TECHNIQUE: Chest, PA and lateral.
COMPARISON: ___.
FINDINGS:
The heart is normal in size. The mediastinal and hilar contours appear within
normal limits. There is no pleural effusion or pneumothorax. The chest is
hyperinflated. The lungs appear clear.
IMPRESSION:
No evidence of acute disease.
|
10070011-RR-37 | 10,070,011 | 28,156,484 | RR | 37 | 2181-09-11 16:01:00 | 2181-09-11 16:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: History: ___ with cough// Pneumonia
TECHNIQUE: Upright AP view of the chest
COMPARISON: None.
FINDINGS:
Heart size is normal. The mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Lungs are hyperinflated but clear. Chain
sutures are seen in the left lung base. No pleural effusion or pneumothorax
is seen. There are no acute osseous abnormalities.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
10070011-RR-38 | 10,070,011 | 28,156,484 | RR | 38 | 2181-09-11 18:28:00 | 2181-09-11 19:17:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ with ___// ?hydro
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
There is no hydronephrosis, large stones, or worrisome masses bilaterally.
Note is made of a right lower pole renal cyst measuring 3.1 x 3.0 x 2.6 cm.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally.
Right kidney: 10.1 cm
Left kidney: 10.3 cm
The bladder is only minimally distended and can not be fully assessed on the
current study.
IMPRESSION:
Normal exam.
|
10070594-RR-17 | 10,070,594 | 29,430,934 | RR | 17 | 2174-01-14 15:52:00 | 2174-01-14 17:34:00 | EXAMINATION:
Chest: Frontal and lateral views
INDICATION: History: ___ with Hypotension, fainting// pna? bleed?
TECHNIQUE: Chest: Frontal and Lateral
COMPARISON: None.
FINDINGS:
Difficult to exclude a subtle lateral right mid lung consolidation. No focal
consolidation is seen elsewhere. There is no pulmonary edema. There is no
large pleural effusion or pneumothorax.
IMPRESSION:
Difficult to exclude a subtle lateral right mid lung consolidation. No focal
consolidation seen elsewhere. Mild cardiomegaly. No pulmonary edema.
|
10070594-RR-18 | 10,070,594 | 29,430,934 | RR | 18 | 2174-01-14 17:16:00 | 2174-01-14 18:41:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with history of liver tumor, presenting with new
rising bili // Gall stone? PVT?
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: ___ CT abdomen and pelvis, ___ abdominal
ultrasound
FINDINGS:
LIVER: The heterogeneous and nodular hepatic parenchyma with an ill-defined
right liver lobe heterogeneous mass, measuring 11 cm x 8 cm, is again seen and
better assessed in the ___ CT abdomen and pelvis.. The main portal
vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no definite intrahepatic biliary dilation. The CHD
measures 6 mm.
GALLBLADDER: Numerous small calcified gallstones are again seen. There is no
evidence of gallbladder wall thickening.
PANCREAS: Extensive overlying bowel gas obscures adequate visualization and
assessment of the pancreas.
SPLEEN: Normal echogenicity, measuring 9.8 cm.
KIDNEYS: Limited views of the right kidney show no hydronephrosis.
There is a 7 x 8 cm right renal simple cyst, that is better assessed in the ___ CT abdomen pelvis.
IMPRESSION:
1. Enlarged heterogeneous liver parenchyma containing several heterogeneous
masses including a 11 x 8 cm right liver lobe mass, better assessed on of ___ CT abdomen pelvis. Patent main portal vein with hepatopetal flow.
2. Cholelithiasis without evidence of acute cholecystitis.
|
10070594-RR-19 | 10,070,594 | 29,430,934 | RR | 19 | 2174-01-14 18:13:00 | 2174-01-14 20:09:00 | EXAMINATION:
CT HEAD W/O CONTRAST
INDICATION: History: ___ with Hypotension, fainting// pna? bleed? pna?
bleed?
TECHNIQUE: Noncontrast enhanced MDCT images of the head were obtained.
Reformatted coronal and sagittal images were also obtained.
DOSE Acquisition sequence:
1) Sequenced Acquisition 8.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
Bilateral hygromas versus chronic subdural hematomas are seen, measuring up to
7 mm on the right and 6 mm on the left. No acute intracranial hemorrhage is
seen. No significant midline shift is seen. No evidence of acute large
vascular territorial infarct is seen. There is mucosal thickening of
bilateral maxillary sinuses. The sphenoid sinuses are relatively
underpneumatized. The mastoid air cells are clear. No acute fracture is
seen.
IMPRESSION:
Bilateral hygromas versus chronic subdural hematomas without significant
midline shift.
No acute intracranial hemorrhage.
|
10070594-RR-20 | 10,070,594 | 29,430,934 | RR | 20 | 2174-01-15 14:26:00 | 2174-01-15 15:27:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with new R PICC// R DL Power PICC 46cm ___ ___
Contact name: ___: ___
IMPRESSION:
In comparison with study of ___, there is an placement of a right
subclavian PICC line that extends to the mid to lower portion of the SVC.
Improved lung volumes with continued mild enlargement of the cardiac
silhouette. Ill-defined heterogeneous area of relative opacification at the
right base could represent a developing consolidation in the appropriate
clinical setting.
|
10070594-RR-21 | 10,070,594 | 29,430,934 | RR | 21 | 2174-01-17 12:40:00 | 2174-01-17 15:55:00 | EXAMINATION: Ultrasound-guided targeted liver biopsy
INDICATION: ___ year old man with large liver mass, with biopsies
inconsistent, initially thought hepatocellular, but recent lymph node biopsy
suggested neuroendocrine tumor, but pt seems to be rapidly progressing out of
proportion to the degree of what was seen of irregularity on the LN biopsy,
need liver biopsy for more tissue for another look at characterization//
please do targeted liver biopsy
COMPARISON: CT of the abdomen and pelvis from ___
PROCEDURE: Ultrasound-guided targeted liver biopsy.
OPERATORS: Dr. ___, radiology fellow and Dr. ___
___, attending radiologist. Dr. ___ personally supervised the
trainee during the key components of the procedure and reviewed and agrees
with the trainee's findings.
FINDINGS:
Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was
performed. The lesion for biopsy was identified in the right hepatic lobe. A
suitable approach for targeted liver biopsy was determined.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
Based on the preprocedure imaging, an appropriate skin entry site for the
biopsy was chosen. The site was marked. The skin was then prepped and draped
in the usual sterile fashion. The superficial soft tissues to the liver
capsule were anesthetized with 10 mL 1% lidocaine.
Under real-time ultrasound guidance, three 18-gauge core biopsy passes were
made.
The skin was then cleaned and a dry sterile dressing was applied. There were
no immediate complications.
SEDATION: Moderate sedation was provided by administering divided doses of
1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of
35 minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
IMPRESSION:
Uncomplicated 18-gauge targeted liver biopsy x 3, with specimen sent to
pathology.
|
10070594-RR-22 | 10,070,594 | 29,430,934 | RR | 22 | 2174-01-18 10:06:00 | 2174-01-18 11:07:00 | EXAMINATION: VENOUS DUP UPPER EXT UNILATERAL
INDICATION: ___ year old man with neuroendopcrince CA on chemo has picc//
right arm is swollen please check for DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the RIGHT upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the right subclavian vein.
The right internal jugular vein is patent, show normal color flow and
compressibility.
There is a PICC in the right basilic vein with an occlusive thrombus noted
around the PICC extending from the basilic into the brachial as well as the
axillary vein respectively. No thrombus noted within the right subclavian or
internal jugular veins.
The left internal jugular and subclavian veins are patent.
IMPRESSION:
Occlusive, acute thrombus surrounding the PICC within the axillary, brachial
and basilic veins on the right side.
No thrombus extending into the subclavian or internal jugular vein on the
right.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 11:05 am, 4 minutes
after discovery of the findings.
|
10070701-RR-16 | 10,070,701 | 27,693,754 | RR | 16 | 2156-10-02 16:49:00 | 2156-10-02 17:23:00 | HISTORY: ___ female with left hip pain after fall 2 days ago.
COMPARISON: None.
FINDINGS:
AP view of the pelvis. Frontal and cross-table lateral views of the left
hip.
There is an acute comminuted intertrochanteric fracture identified through the
left femur. There is associated valgus angulation of the main fracture
fragments as well as some impaction. The lesser trochanter appears as a
separate fracture fragment. The femoral head is anatomically aligned with
the acetabulum. Bones are diffusely osteopenic. No other fracture
identified. Pubic symphysis and SI joints are unremarkable. Diffuse
atherosclerotic calcifications are noted.
IMPRESSION:
Acute, comminuted, angulated intertrochanteric fracture of the left femur.
|
10070701-RR-17 | 10,070,701 | 27,693,754 | RR | 17 | 2156-10-02 16:49:00 | 2156-10-02 17:19:00 | HISTORY: ___ female with left hip pain after fall 2 days ago,
pre-op.
COMPARISON: None.
FINDINGS:
Single supine view of the chest. The lungs are clear of consolidation.
Cardiac silhouette is slightly enlarged. Increased soft tissue density in the
retrocardiac region on the right may represent the left atrium or potentially
a hiatal hernia. Atherosclerotic calcifications noted in the aorta. No acute
osseous abnormality detected. Old anterior right rib fracture is identified.
IMPRESSION:
No acute cardiopulmonary process. Possible hiatal hernia versus pronounced
left atrium. Two-view chest x-ray may help further characterize if desired.
|
10070701-RR-18 | 10,070,701 | 27,693,754 | RR | 18 | 2156-10-02 16:19:00 | 2156-10-02 17:15:00 | HISTORY: Fall.
COMPARISON: None available.
TECHNIQUE: Contiguous axial images were obtained through the brain without
intravenous contrast. Multiplanar reformatted images were prepared and
reviewed.
FINDINGS:
There is no evidence of an acute intracranial hemorrhage, edema, large vessel
territory infarction, or shift of the midline structures. Chronic right basal
ganglia lacunes (2:12) and remote appearing left cerebellar infarct are noted
(2:10). Gray-white matter differentiation appears well preserved. No acute
fractures are identified. There is thickening of the walls of the right
maxillary sinus suggestive of a history of chronic sinusitis. The visualized
mastoid air cells and paranasal sinuses are clear at this time. Extensive
intracranial vascular atherosclerotic calcifications are noted.
IMPRESSION:
No acute intracranial injury.
|
10070701-RR-19 | 10,070,701 | 27,693,754 | RR | 19 | 2156-10-02 16:19:00 | 2156-10-02 17:20:00 | HISTORY: Trauma.
COMPARISON: CT head from same day.
TECHNIQUE: MDCT-acquired axial images were obtained through the cervical
spine without intravenous contrast. Multiplanar reformatted images were
prepared and reviewed.
FINDINGS:
Partially imaged is a mild compression deformity of the T3 vertebral body,
likely chronic, with no retropulsion detected. There is no evidence of
prevertebral soft tissue swelling, malalignment, or acute cervical spine
fracture. Moderate multilevel degenerative changes are present throughout the
cervical spine with loss of disc height, small posterior osteophytes and disc
bulges. Mild central canal narrowing is most severe at C3/4 and C4/5, though
no critical central canal stenosis is present. Multilevel bilateral neural
foraminal narrowing is also present, moderate to severe in extent.
The visualized lung apices are clear. The visualized thyroid gland appears
diffusely enlarged with multiple nodules, consistent with a multinodular
goiter. Vascular calcifications are noted throughout the vertebral and
internal carotid arteries.
IMPRESSION:
1. Mild compression deformity of the T3 vertebral body, partially visualized,
and likely chronic. No evidence of acute cervical spine fracture,
malalignment, or prevertebral soft tissue swelling.
2. Multinodular thyroid goiter.
|
10070701-RR-21 | 10,070,701 | 27,693,754 | RR | 21 | 2156-10-03 10:41:00 | 2156-10-03 11:01:00 | HISTORY: ORIF.
FINDINGS: Images from the operating suite show placement of a gamma nail
across the previous fracture of the proximal femur. Further information can
be gathered from the operative report.
|
10070701-RR-22 | 10,070,701 | 27,693,754 | RR | 22 | 2156-10-04 18:37:00 | 2156-10-05 08:17:00 | PELVIS AND LEFT HIP, POSTOPERATIVE CONTROL
FINDINGS: The patient is after ORIF of the left hip. The ORIF components are
in correct position. Known small bony fragment at the level of the minor
trochanter on the left. Extensive vascular calcifications. No other
abnormalities.
|
10070932-RR-27 | 10,070,932 | 28,249,049 | RR | 27 | 2145-12-01 14:15:00 | 2145-12-01 15:19:00 | INDICATION: ___ year old woman with c diff, bacteremia, crackles// r/o chf v
pna
COMPARISON: ___
IMPRESSION:
The left-sided PICC line has been removed. Heart size is within normal
limits. There are no focal consolidations, pleural effusion, or pulmonary
edema. There are no pneumothoraces.
|
10070932-RR-28 | 10,070,932 | 28,249,049 | RR | 28 | 2145-12-03 12:16:00 | 2145-12-03 15:28:00 | INDICATION: ___ year old woman with left PICC// Left 45cm PICC ___ ___
Contact name: ___: ___
TECHNIQUE: Portable AP chest
COMPARISON: Multiple prior chest radiographs, most recent dated ___.
FINDINGS:
Normal lung expansion. No obvious pulmonary nodules or areas of focal
consolidation. No pleural effusion or pneumothorax. Interval placement of a
left-sided PICC, which terminates in the distal SVC.
IMPRESSION:
Left-sided PICC terminates in the distal SVC. No pneumothorax.
|
10070932-RR-32 | 10,070,932 | 24,727,163 | RR | 32 | 2146-05-11 17:53:00 | 2146-05-11 18:16:00 | INDICATION: NO_PO contrast; History: ___ with ___ with complex PMH notable
for multiple line infections and recent admission for E. coli UTI and C. diff
colitis, now presenting with fever to 103 at home and left flank pain, UA
consistent w/ UTI.NO_PO contrast// ?nephrolithiasis, hydronephrosis
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was not administered.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.8 s, 45.3 cm; CTDIvol = 7.9 mGy (Body) DLP = 355.8
mGy-cm.
Total DLP (Body) = 356 mGy-cm.
COMPARISON: None.
___ CT abdomen and pelvis with IV contrast ___ facility
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality. Left extrarenal pelvis is noted.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. No bowel obstruction or bowel
wall thickening is seen. The appendix is normal in caliber.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits. Sacral
nerve stimulator device is noted in unchanged position.
IMPRESSION:
1. No nephrolithiasis or hydronephrosis.
2. No acute abnormality within the imaged abdomen and pelvis within the
limitations of this noncontrast enhanced study.
3. Status post cholecystectomy.
|
10071766-RR-16 | 10,071,766 | 25,291,316 | RR | 16 | 2163-06-04 15:15:00 | 2163-06-04 16:20:00 | HISTORY: Syncope. Evaluate for cardiomegaly, edema or effusion.
TECHNIQUE: Frontal and lateral chest radiographs were obtained of the patient
in the upright position.
COMPARISON: None available.
FINDINGS: Lungs are clear without any focal opacities, pleural effusion or
pulmonary edema. There is no pneumothorax. The cardiac and mediastinal
contours are normal. An expansile lesion involving the third right posterior
rib is of indeterminate etiology. Please correlate for any clinical history
of osseous malignancy (i.e. multiple myeloma) or prior imaging to assess
stability.
IMPRESSION:
1. No acute cardiopulmonary process.
2. Expansile lesion of the right third posterior rib of indeterminate
etiology. Recommend clinical correlation for any history of osseous
malignancy (i.e. multiple myeloma) and comparison with prior imaging to assess
stability.
|
10071766-RR-17 | 10,071,766 | 25,291,316 | RR | 17 | 2163-06-04 15:35:00 | 2163-06-04 15:57:00 | HISTORY: ___ male with seizures and headache.
TECHNIQUE: Contiguous axial MDCT images were obtained through the brain
without the administration of intravenous contrast. Reformatted coronal,
sagittal and thin slice images were reviewed.
COMPARISON: None available.
FINDINGS: There is no evidence of intracranial hemorrhage, acute major
vascular territorial infarction, shift of the normally midline structures,
mass effect or edema. The ventricles and sulci are normal in size and
configuration. The basal cisterns appear patent. The gray-white matter
differentiation is preserved. No fractures are identified. The cranial and
facial soft tissues are unremarkable. The orbits are unremarkable.
Bilateral mastoid air cell opacification as well as opacification of the
ethmoid air cells and sphenoid sinuses, with mucosal thickening in the frontal
sinuses is present. The bilateral middle ear cavities are clear.
IMPRESSION:
1. No acute intracranial process.
2. Pansinus inflammatory disease and bilateral mastoid air cell
opacification.
|
10071766-RR-18 | 10,071,766 | 25,291,316 | RR | 18 | 2163-06-04 20:54:00 | 2163-06-06 12:19:00 | EXAM: CTA of the head.
CLINICAL INFORMATION: Patient with syncope and lightheadedness.
TECHNIQUE: Axial images of the head were obtained without contrast.
Following this, using departmental protocol, CT angiography of the head and
neck was acquired. 3D reformatted images were obtained on an independent
workstation.
FINDINGS:
Head CT shows moderate brain atrophy which is somewhat out of proportion for
patient's age. There is no acute hemorrhage. There is no loss of gray-white
matter differentiation.
CT angiography of the neck demonstrates calcification of both carotid
bifurcations. There is an approximately 50% narrowing of the right proximal
internal carotid artery. No significant narrowing is seen at the left carotid
bifurcation. Both vertebral arteries are patent in the neck.
CT angiography of the head shows nonvisualization of the distal right
vertebral artery. On the curved reformatted images, there appears to be
apparent narrowing of the distal right vertebral artery; however, on the
coronal reformats, this segment is not well visualized and the right vertebral
artery appears to be ending in a prominent posterior inferior cerebellar
artery. These findings are suggestive of congenital, somewhat hypoplastic
distal V4 segment of the right vertebral artery occlusive disease. In
addition, there are no hyperdensities seen within the area to suggest
thrombus. Otherwise, the arteries of anterior and posterior circulation are
patent without stenosis or occlusion.
IMPRESSION:
1. Head CT shows moderate brain atrophy, which is out of proportion to sulci.
No hemorrhage.
2. CT angiography of the neck shows 50% stenosis with calcification of the
right proximal internal carotid artery with mild calcification and
atherosclerotic disease without calcification at the left carotid carotid
bifurcation.
3. Patent vertebral arteries.
4. Likely hypoplastic distal right vertebral artery, predominantly ending in
posterior inferior cerebellar artery. Otherwise, the intracranial arteries
are patent without stenosis, occlusion, or aneurysm greater than 3 mm in size.
5. Soft tissue changes in the maxillary, sphenoid, ethmoid and frontal
sinuses with high-density material in the right maxillary sinus suggestive of
inspissated secretions and chronic sinusitis.
|
10071795-RR-60 | 10,071,795 | 24,331,732 | RR | 60 | 2173-04-22 02:08:00 | 2173-04-22 03:29:00 | EXAMINATION: PELVIS U.S., TRANSVAGINAL
INDICATION: History: ___ with abd/pelvic pain, fever, vaginal d/c// ?abscess
TECHNIQUE: Grayscale and Doppler ultrasound images of the pelvis were
obtained with transabdominal approach followed by transvaginal approach for
further delineation of uterine anatomy.
COMPARISON:
CT abdomen pelvis from same day ___.
FINDINGS:
The uterus is anteverted. The uterus is enlarged measuring 12.2 x 5.6 x 7.9
cm. There are multiple masses consistent with fibroids. The largest fibroid
is located left aspect of the uterus and measures 5.2 cm. The endometrium is
homogenous and measures 11 mm.
The right ovary contains a 6.1 x 3.5 x 5.5 cm multiloculated paraovarian
complex cystic structure with fluid-fluid levels and thickened walls and no
internal vascularity, which appears to be distinct from the right ovary but
abutting it. The left ovary is normal. There is no free fluid.
IMPRESSION:
Sonographic findings consistent with right tubo-ovarian abscess.
|
10071795-RR-61 | 10,071,795 | 24,331,732 | RR | 61 | 2173-04-22 02:13:00 | 2173-04-22 04:07:00 | INDICATION: ___ with fever and RLQ painNO_PO contrast// ?acute process
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen and pelvis following intravenous contrast
administration with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE:
Total DLP (Body) = 504 mGy-cm.
COMPARISON: Pelvic ultrasound from same day ___.
CT abdomen pelvis ___.
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: Patient is status post partial right hepatectomy with
postsurgical changes. Otherwise, the remaining liver demonstrates homogenous
attenuation throughout. There is no evidence of focal lesions. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. Incidental note is made of a small accessory
spleen (02:25).
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: As demonstrated on ultrasound, there is a multiloculated
right complex ovarian cystic lesion with thick enhancing walls consistent with
an abscess (2:58, 601:27). This lesion measures approximately 5.4 x 3.6 cm in
conglomerate ___. In the left adnexa there is a complex cystic
structure with thickened walls and a central density which may correspond to a
left-sided fibroid seen on ultrasound or may represent a hemorrhagic cyst
(02:58). Also, a left adnexal abscess cannot be excluded. Otherwise, there
is enlarged uterus with multiple noncalcified fibroids.
LYMPH NODES: There are several non pathologically enlarged retroperitoneal and
iliac lymph nodes, likely reactive (02:38, 62). Otherwise, there is no
retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal
lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic
disease is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Right complex ovarian cyst consistent with tubo-ovarian abscess, as
correlated on same day ultrasound.
2. Left adnexal complex cystic lesion likely corresponds to a necrosis
fibroid. However, a left adnexal hemorrhagic cyst or abscess cannot be
excluded.
3. Prominent retroperitoneal and iliac lymph nodes likely reactive.
|
10071795-RR-62 | 10,071,795 | 24,331,732 | RR | 62 | 2173-04-22 14:30:00 | 2173-04-22 16:12:00 | EXAMINATION: Ultrasound-guided pelvic aspiration
INDICATION: ___ year old woman with abdominal pain, fever at home, admitted
for treatment of ___// drainage ___
COMPARISON: CT abdomen and pelvis on ___, pelvic ultrasound
performed earlier on same day on ___
PROCEDURE: Ultrasound-guided drainage of right pelvic collection.
OPERATORS: Dr. ___ trainee and Dr. ___ Dr.
___ radiologists. Dr. ___ Dr. ___
supervised the trainee during the key components of the procedure and reviewed
and agree with the trainee's findings.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
The patient was placed in a supine position on the US scan table in lithotomy
position. Limited preprocedure transvaginal ultrasound was performed to
localize the collection. Based on the transvaginal ultrasound findings an
appropriate trajectory was chosen. Patient was sterilized with Betadine
internally and externally. Local anesthesia was administered with 1%
Lidocaine solution.
Using continuous sonographic guidance, 18G ___ needle was inserted into
the collection. A sample of fluid was aspirated, confirming needle position
within the collection.
Approximately 17 cc of purulent fluid was aspirated with a sample sent for
microbiology evaluation. The needle was removed.
The procedure was tolerated well, and there were no immediate post-procedural
complications.
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 15
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
FINDINGS:
Complex right adnexal fluid collection, as seen on ultrasound and CT performed
earlier on same day.
IMPRESSION:
Successful US-guided aspiration of a right tubo-ovarian abscess. 17 cc of
purulent fluid was drained. Sample was sent for microbiology evaluation.
|
10072214-RR-11 | 10,072,214 | 29,071,979 | RR | 11 | 2156-11-20 05:41:00 | 2156-11-20 10:43:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old woman with left face/arm/leg weakness.// Evaluate for
infact
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON Head CT ___ performed at TCC Ortho.
FINDINGS:
There is a focus of slow diffusion in the right thalamus extending into the
right cerebral peduncle. There is no associated hemorrhage. This region is
faintly hyperintense on the FLAIR images suggesting a subacute infarction.
Images of the remainder of the brain appear normal. No other areas of
infarction are detected. There is no evidence of hemorrhage, edema or masses.
The ventricles and sulci are normal in caliber and configuration.
IMPRESSION:
1. Right thalamic subacute infarction.
NOTIFICATION: The finding of a right thalamic subacute infarction was
discussed with Dr. ___ by telephone by Dr. ___ at 10:40 ___
10 minutes after making the observation.
|
10072264-RR-12 | 10,072,264 | 28,943,956 | RR | 12 | 2157-05-12 18:42:00 | 2157-05-12 19:01:00 | EXAMINATION: CHEST (AP AND LAT)
INDICATION: History: ___ with cirrhosis, portal hypertension
TECHNIQUE: Upright AP and lateral views of the chest
COMPARISON: Chest radiograph ___
FINDINGS:
Lung volumes are low. Cardiac silhouette size is mildly enlarged but similar
to the previous examination. Mediastinal and hilar contours are unchanged
with similar enlargement of the pulmonary arteries bilaterally. Crowding of
bronchovascular structures is present without overt pulmonary edema. Patchy
atelectasis is seen in the lung bases without focal consolidation. Blunting
of the right costophrenic angle persists, potentially reflective of a trace
right pleural effusion. No left-sided pleural effusion or pneumothorax is
present. There are no acute osseous abnormalities.
IMPRESSION:
Low lung volumes. Bibasilar atelectasis and possible trace right pleural
effusion. Unchanged mild cardiomegaly without pulmonary edema.
|
10072264-RR-13 | 10,072,264 | 28,943,956 | RR | 13 | 2157-05-12 18:19:00 | 2157-05-12 18:48:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: End-stage renal disease and liver failure, history of portal
hypertension.
TECHNIQUE: Gray scale, color and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: CT abdomen dated ___.
FINDINGS:
LIVER: The liver is coarsened in echotexture. The contour of the liver is
smooth. There is no focal liver mass. The main portal vein is patent with
hepatopetal flow. There is large volume ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 3 mm.
Gallbladder: Gallbladder wall edema is noted, likely secondary to third
spacing. There is no gallbladder distention or cholelithiasis identified.
Spleen: The spleen demonstrates normal echotexture, and measures 16.6 cm.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 15 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein and superior mesenteric vein are patent, with antegrade flow.
IMPRESSION:
1. Patent hepatic vasculature.
2. Persistent sequelae of portal hypertension, including large volume
ascites, splenomegaly, and gallbladder wall edema.
3. Coarsened hepatic echotexture compatible with cirrhosis without focal
lesion.
|
10072264-RR-14 | 10,072,264 | 28,943,956 | RR | 14 | 2157-05-12 19:37:00 | 2157-05-12 21:14:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: History: ___ with fall yesterday, severe liver disease
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles
and sulci are normal in size and configuration. Scattered parenchymal
calcifications are noted bilaterally, potentially dystrophic or the sequela of
previous infection or inflammation. There is preservation of gray-white
matter differentiation. The basal cisterns remain patent.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Calcifications
are seen in the bilateral cavernous carotid arteries and distal left vertebral
artery. The visualized portion of the orbits are unremarkable.
IMPRESSION:
No evidence for acute intracranial process.
|
10072799-RR-15 | 10,072,799 | 28,944,995 | RR | 15 | 2137-01-29 20:42:00 | 2137-01-29 21:16:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with gait ataxia and right hemifacial spasm, new since
discharge yesterday from neurology after work up for HA and right arm and leg
pain.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP: 803 mGy-cm
COMPARISON: MRI from ___.
FINDINGS:
There is no evidence of acute infarction,hemorrhage,edema, or mass. Ventricles
and sulci are symmetric and unremarkable.
There is no evidence of acute fracture. Trace mucosal thickening of the
ethmoid air cells are again noted. The visualized portion of the remaining
paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The
visualized portion of the orbits are unremarkable.
IMPRESSION:
No acute intracranial abnormalities. However, please note that acute ischemic
changes are better detected on MRI.
|
10072945-RR-10 | 10,072,945 | 24,421,237 | RR | 10 | 2114-02-13 12:46:00 | 2114-02-13 13:11:00 | CHEST RADIOGRAPHS.
HISTORY: Cough and fever.
COMPARISONS: None.
TECHNIQUE: Chest, PA and lateral.
FINDINGS: The heart is normal in size. The mediastinal and hilar contours
appear within normal limits. The lungs appear clear. There is no pleural
effusion or pneumothorax. The chest is hyperinflated. Mid thoracic
interspaces are mildly narrowed. Very small anterior osteophytes are visible
throughout the thoracic spine.
IMPRESSION: No evidence of acute cardiopulmonary disease. Hyperinflation.
|
10072945-RR-11 | 10,072,945 | 24,421,237 | RR | 11 | 2114-02-16 16:53:00 | 2114-02-16 19:11:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with COPD exacerbation with poor recovery //
pneumonia
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the lung volumes remain high, likely
reflecting overinflation. However, there is no other parenchymal abnormality,
notably no evidence of pneumonia or pulmonary edema. The size of the cardiac
silhouette is normal. Mild scoliosis of the thoracic spine. Causes asymmetry
of the ribcage. Normal hilar and mediastinal structures.
|
10072945-RR-12 | 10,072,945 | 24,421,237 | RR | 12 | 2114-02-17 11:51:00 | 2114-02-17 13:36:00 | INDICATION: ___ female with shortness of breath.
COMPARISON: Chest radiograph ___.
TECHNIQUE: Axial MDCT images were obtained through the chest in the arterial
phase after the administration of Omnipaque intravenous contrast material.
Coronal and sagittal reformats as well as maximum intensity oblique projection
images were also obtained.
DLP: 356.02 mGy-cm.
CTDIvol: 11.14 mGy.
FINDINGS: The aorta and pulmonary arteries are well opacified. There is no
pulmonary embolism to the subsegmental level. The aorta maintains a normal
caliber without any evidence of acute aortic syndrome. The heart is normal in
size without pericardial effusion. There is no pleural effusion. There is no
mediastinal or hilar lymphadenopathy.
The central airways remain patent. In the superior aspects of the right and
left lower lobes are some areas of centrilobular nodules, worse on the right,
concerning for multifocal pneumonia or aspiration. There is no lung nodule or
mass concerning for malignancy. Mild centrilobular emphysematous changes are
noted. There is no pneumothorax.
The visualized portions of the upper abdomen are unremarkable. No suspicious
lesion is seen in visualized osseous structures.
IMPRESSION:
1. No pulmonary embolism.
2. Bilateral centrilobular nodules, concerning for aspiration or multifocal
pneumonia.
3. Centrilobular emphysema.
Dr. ___ Item 1 and 2 in the Impression to Dr. ___
telephone at ___ at 1:20 p.m.
|
10073182-RR-60 | 10,073,182 | 23,441,084 | RR | 60 | 2134-10-31 17:23:00 | 2134-10-31 19:43:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with fever, hypoxia // ? acute pathology
IMPRESSION:
As compared to ___ radiograph, bilateral interstitial opacities
affecting the left lung to a greater degree than the right have worsened, and
may reflect asymmetrical edema or atypical pneumonia. Small left pleural
effusion is also evident. No other relevant changes.
|
10073248-RR-10 | 10,073,248 | 20,220,513 | RR | 10 | 2183-07-20 00:01:00 | 2183-07-20 10:20:00 | EXAMINATION: MRV HEAD W/O CONTRAST
INDICATION: ___ p/w proteinuria, ___, anasarca c/f nephrotic syndrome//
?Cerebral venous thrombosis
TECHNIQUE: 3D phase-contrast MRV of the head was obtained. Sagittal T1
weighted imaging was performed. Three dimensional maximum intensity projection
and segmented images of the MRV were then generated. This report is based on
interpretation of all of these images.
COMPARISON: None.
FINDINGS:
MRV: Normal flow signal is demonstrated within the superior sagittal sinus,
straight sinus, transverse sinuses, and sigmoid sinuses, although the right
transverse sinus is slightly diminutive, likely congenital. The jugular bulbs
and proximal jugular veins are patent. Evaluation of the deep venous systems
reveals normal flow signal in the internal cerebral veins. The vein ___
is also unremarkable.
IMPRESSION:
No evidence of cerebral venous thrombosis.
|
10073248-RR-8 | 10,073,248 | 20,220,513 | RR | 8 | 2183-07-17 17:33:00 | 2183-07-17 18:06:00 | EXAMINATION: RENAL U.S.
INDICATION: ___ with bilat UE and ___ edema, Cr 2.0, proteinuria// Eval for
parenchymal abnormalities, hydronephrosis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the kidneys were
obtained.
COMPARISON: None.
FINDINGS:
There is no hydronephrosis, definite stones, or insert masses bilaterally.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally.
Right kidney: 12.2 cm
Left kidney: 13.0
The bladder is moderately well distended and normal in appearance. Trace
amount of pelvic free-fluid.
IMPRESSION:
Normal renal ultrasound.
|
10073248-RR-9 | 10,073,248 | 20,220,513 | RR | 9 | 2183-07-18 20:32:00 | 2183-07-18 21:14:00 | EXAMINATION: UNILAT UP EXT VEINS US RIGHT
INDICATION: ___ year old man with nephrotic syndrome with RUE edema > LUE//
?DVT
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular, axillary, and brachial veins are patent, show
normal color flow, spectral doppler, and compressibility. The right basilic,
and cephalic veins are patent, compressible and show normal color flow.
Moderate overlying subcutaneous edema is incidentally noted.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity.
|
10073646-RR-2 | 10,073,646 | 26,724,486 | RR | 2 | 2147-04-16 21:15:00 | 2147-04-17 09:52:00 | REASON FOR EXAMINATION: Evaluation of the patient with recent right lower
lobe pneumonia and right upper lung consolidation.
AP radiograph of the chest was reviewed in comparison to prior study obtained
the same day earlier.
Cardiomediastinal silhouette is unchanged including substantial cardiomegaly.
Right upper lobe opacity as well as left upper lobe opacity are overall
unchanged. Old rib fractures are noted. Right pleural effusion is small,
unchanged. No pneumothorax is seen. Bibasal consolidations are better
depicted on the CT abdomen obtained the same day.
|
10073646-RR-3 | 10,073,646 | 26,724,486 | RR | 3 | 2147-04-18 16:23:00 | 2147-04-18 17:40:00 | REASON FOR EXAMINATION: Evaluation of the patient with diastolic congestive
heart failure, multiple myeloma, recent pneumonia and currently with
persistent opacities, reassessment.
COMPARISON: Chest radiograph from ___, and CT abdomen obtained the
same day, ___.
TECHNIQUE: MDCT of the chest was obtained from thoracic inlet to upper
abdomen without administration of IV contrast. Axial images were reviewed in
conjunction with coronal and sagittal reformats.
FINDINGS:
Dilatation of the main pulmonary artery, up to 4 cm is consistent with
pulmonary hypertension. Heart size is enlarged. There is small amount of
pericardial effusion. There is bilateral pleural effusion, moderate that when
compared with the CT abdomen obtained two days ago demonstrate enlargement,
especially on the right. There is no definitive mediastinal, hilar or
axillary lymphadenopathy. For the assessment of the upper abdomen, please
review recent CT abdomen and the corresponding report and no substantial
change since the prior study has been demonstrated. Airways are patent till
the subsegmental level bilaterally.
Assessment of the imaged portion of the skeleton demonstrates innumerable
lytic lesions consistent with known history of multiple myeloma. Compression
fractures of the predominantly upper thoracic vertebral bodies demonstrated,
also accentuated by the presence of substantial kyphosis. Multiple rib
fractures are noted bilaterally. Fractures of the sternum are noted,
extensive.
Right lower lobe opacity is noted, most likely consistent with infectious
process as well as lingular consolidation and to a lesser extent left basal
opacity that might potentially represents an area of atelectasis. Right basal
consolidation is out of proportion to the amount of pleural effusion thus the
whole appearance is highly concerning for multifocal infection. In the
absence of prior cross-sectional imaging, assessment of the dynamic changes
cannot be obtained. Overall, the appearance is similar to chest radiographs
obtained two days ago.
|
10073646-RR-4 | 10,073,646 | 26,724,486 | RR | 4 | 2147-04-19 05:51:00 | 2147-04-19 15:15:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with PNA, found to be hypoxic to 80 on RA
(improved w/O2) // assess for interval change
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiographs on ___ and chest CT from ___
FINDINGS:
There is substantial cardiomegaly. A left lower lobe opacity is overall
unchanged from the prior exam. There is likely a small right pleural
effusion, which is unchanged. There is no evidence of pneumothorax. No other
significant change from the prior study.
IMPRESSION:
Left lower lobe opacity not significantly changed. No significant change from
the prior exam.
|
10073646-RR-5 | 10,073,646 | 26,724,486 | RR | 5 | 2147-04-23 10:40:00 | 2147-04-23 11:20:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ year old woman with influenza and HCAP. // eval for interval
change
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, the pre-existing left-sided opacity is
minimally improved. The opacities at both the left and the right lung basis
are constant in appearance. No new all rib fractures. Moderate cardiomegaly
with minimal fluid overload persists. Unchanged minimal pleural effusions. .
|
10073847-RR-42 | 10,073,847 | 27,496,246 | RR | 42 | 2135-01-17 19:36:00 | 2135-01-17 20:23:00 | INDICATION: ___ year old male with non-Hodgkin's lymphoma, concern for
leptomeningeal spread on recent L-spine MRI.
Correlation to L-spine MR from ___.
TECHNIQUE: Contiguous non-contrast axial images were obtained through the
brain at 5-mm intervals. 2-mm coronal and sagittal multiplanar reformats were
also generated.
FINDINGS: There is no acute intracranial hemorrhage, edema, mass effect, or
vascular territorial infarct. Gray-white matter differentiation is preserved.
Midline structures are intact. The ventricles and sulci are normal in size
and morphology. Calcifications are noted in the bilateral cavernous carotid
arteries and vertebral arteries.
Mild mucosal thickening is noted throughout the ethmoid and maxillary sinuses.
There are air-fluid levels in the bilateral maxillary sinuses, right greater
than left, with aerosolized secretions on the right. Mastoid air cells and
middle ear cavities are clear.
Note is made of mild hyperostosis frontalis interna.
IMPRESSION: No acute intracranial process. Please note that MRI with
contrast would be more sensitive for detection of small intracranial lesions.
|
10073847-RR-43 | 10,073,847 | 27,496,246 | RR | 43 | 2135-01-18 11:52:00 | 2135-01-18 16:04:00 | INDICATION: Lymphoma, in remission, no concern for leptomeningeal spread, to
evaluate for mets.
COMPARISON: MR ___ done on ___. No prior head studies.
TECHNIQUE: MR of the head without and with IV contrast.
FINDINGS:
A few small periventricular hyperintense foci are noted on the FLAIR sequence.
Otherwise, no focal lesions are noted in the brain parenchyma. There is no
focus of abnormal enhancement in the brain parenchyma or in the meninges on
the spin echo images provided. Increased signal intensity and enhancement is
noted in the left mastoid air cells from fluid/mucosal thickening. Assessment
for leptomeningeal enhancement in particular in the IACs is limited on the
MP-RAGE sequence. No obvious abnormal enhancement is noted in the cerebral
sulci or the ventricles. The major intracranial arterial flow voids are noted.
Focal prominence of the right ICA termination which needs further evaluation
with MR angiogram to exclude a small aneurysm in this location (series 8,
image 13). There is no focus of decreased diffusion or negative
susceptibility. Minimal mucosal thickening is noted in the ethmoid air cells
along with fluid and mucosal thickening in the right maxillary sinus.
IMPRESSION:
1. Few nonspecific FLAIR hyperintense foci. No foci of abnormal enhancement
in the brain parenchyma or in the CSF spaces, in the head to suggest
leptomeningeal enhancement, assessment of the IACs is somewhat limited. Please
note that even though there is no definite abnormal enhancement on the MR
images, leptomeningeal involvement cannot be completely excluded, in
particular given the appearance of the thecal sac and the nerves of the thecal
sac on the prior MR ___ study. Correlate with CSF analysis for excluding
leptomeningeal enhancement and consider close followup as clinically
indicated.
2. Fluid and mucosal thickening in the left mastoid air cells, right
maxillary sinus as described above.
3. Small focal prominence at the right ICA termination measuring
approximately 4 mm, which needs further evaluation with MR angiogram to
exclude a small aneurysm.
|
10073847-RR-44 | 10,073,847 | 27,496,246 | RR | 44 | 2135-01-18 14:37:00 | 2135-01-18 18:41:00 | INDICATION: History of DLBCL status post of REPOCH x6 and MTX x4 with likely
recurrence around the cauda equina. Evaluate for disease recurrence.
CT TORSO: MDCT imaging was performed from the thoracic inlet to the pubic
symphysis after the uneventful intravenous administration of contrast. Oral
contrast was also administered. Sagittal and coronal reformats were
performed.
COMPARISON: MRI lumbar spine, ___, PET CT ___.
CHEST: Bibasilar plate-like atelectasis is present in the lower lungs
bilaterally. No pulmonary nodules, however, are present. The airways are
patent to the subsegmental levels bilaterally. No pleural effusions are
present. There is mild-to-moderate atherosclerotic calcification of the left
coronary artery. No pericardial effusion is present. Otherwise, the heart
and great vessels appear normal. No pathologically enlarged lymph nodes are
present in the axilla, hilum, or mediastinum. The thyroid appears normal.
ABDOMEN: The spleen appears normal. In the left adrenal gland is a stable 32
x 27 mm mass. The right adrenal gland and the pancreas are normal in their
appearance. The liver and gallbladder appear normal. The enhancement and
excretion of contrast from the kidneys is symmetric without masses or
hydronephrosis. The abdominal aorta and its branches appear normal in
caliber. No free air or free fluid is present. Scattered non-pathologically
enlarged retroperitoneal lymph nodes are present. No significant mesenteric
lymphadenopathy is present. The stomach and abdominal loops of bowel appear
normal.
PELVIS: The bladder is well distended with urine and appears normal. No free
air or free fluid or significant adenopathy is present.
BONE WINDOWS: There is a stable 3.5 x 2.9 cm lytic lesion in the right pubic
ramus which is stable in its appearance. There is a chronic, well-corticated
healed fracture of the right inferior pubic ramus (2:132). Evaluation of
intrathecal contents in the lower lumbar spine is suboptimal on this
examination. No definite soft tissue mass is identified.
IMPRESSION:
1. Stable lytic lesion in the right pubic ramus. Healed fracture of the
right inferior pubic ramus.
2. No definite evidence for disease recurrence. Evaluation for intrathecal
disease is limited on this examination and if further evaluation of
intrathecal contents is desired, a MRI of the lumbar spine should be
performed.
3. Stable 3.2cm left adrenal mass, which is indeterminate. Recommend
endocrine evaluation for further evaluation.
|
10073847-RR-45 | 10,073,847 | 27,496,246 | RR | 45 | 2135-01-19 14:39:00 | 2135-01-19 17:56:00 | INDICATION: Diffuse large B-cell lymphoma with known intradural metastasis
seen on recent MR scan of the lumbar spine.
TECHNIQUE: Sagittal T2, sagittal T1, sagittal STIR, axial T2, and axial T2
star weighted MR imaging of the cervical spine was obtained prior to the
administration of contrast. Sagittal T2, sagittal T1, sagittal STIR and axial
T2-weighted pre-contrast MR imaging of the thoracic spine was also obtained.
Subsequently, sagittal and axial T1 post-contrast imaging of the thoracic and
cervical spine was obtained after the administration of 22 cc IV Magnevist
contrast.
COMPARISON: Correlation with prompting MR of the L-spine dated ___ and review of CT torso dated ___.
FINDINGS:
CERVICAL SPINE: Alignment of the cervical spine is normal. The bone marrow
signal is within normal limits. No abnormal signal is seen within the spinal
cord. No evidence of space-occupying lesion or abnormal enhancement is seen
after the administration of contrast. There are multilevel degenerative
changes as described below:
At C4-C5, left-sided uncovertebral hypertrophy causes mild-to-moderate
left-sided neural foraminal narrowing.
At C5-C6, there is a left-sided disc protrusion with osteophyte formation
indenting the spinal cord.
The para- and prevertebral soft tissues appear grossly normal. No
lymphadenopathy is identified.
THORACIC SPINE: Alignment of the thoracic spine is normal. No evidence of
bone marrow signal abnormality is seen.
On post-contrast images, previously-seen enhancing lesion within the anterior
aspect of the thecal sac, beginning at the level of L1 is redemonstrated,
causing posterior displacement of the conus medullaris. In addition to this,
leptomeningeal enhancement is seen beginning at the level of the inferior
endplate of T10, extending inferiorly to the level of the previously seen
lesion (14:8). No bone marrow abnormality is identified. The paraspinal soft
tissues appear grossly normal. No significant degenerative changes are
present.
Again seen is a 3.1 x 2.4 cm left adrenal lesion (13:14), which appears to
enhance slightly; however, this is incompletely evaluated on this examination.
IMPRESSION:
1. Redemonstration of the lesion at the level of L1 extending caudally.
Additionally, less marked leptomeningeal enhancement is seen beginning at the
level of the inferior endplate of T10 extending inferiorly to the previously
seen lesion, consistent with leptomeningeal involvement by lymphoma.
2. No evidence of bone marrow abnormality or paravertebral or epidural soft
tissue lesion.
3. Degenerative changes of the cervical spine, most marked at C5/C6 where a
disc-osteophyte complex contacts the left anterolateral aspect of the spinal
cord, with no abnormality of intrinsic cord signal at that level.
4. Indeterminate left adrenal nodule, as previously noted.
|
10074282-RR-33 | 10,074,282 | 29,469,637 | RR | 33 | 2159-10-19 15:13:00 | 2159-10-19 16:12:00 | CHEST, TWO VIEWS: ___
HISTORY: ___ female with worsening weakness, diagnosed with the flu
one week ago.
COMPARISON: None.
FINDINGS: Frontal and lateral views of the chest. Relatively low lung
volumes are seen; however, the lungs are clear without focal consolidation or
effusion. The cardiomediastinal silhouette is within normal limits. Severe
degenerative changes noted at the right shoulder. No acute osseous
abnormality is identified.
IMPRESSION: No definite acute cardiopulmonary process.
|
10074282-RR-34 | 10,074,282 | 29,469,637 | RR | 34 | 2159-10-19 20:55:00 | 2159-10-20 16:13:00 | EXAMINATION: ABDOMEN (SUPINE AND ERECT)
INDICATION: ___ year old woman with dementia, vomiting, abdominal pain,
emesis, and new weakness. Evaluate for obstruction, constipation.
TECHNIQUE: Portable and upright radiographs of the abdomen
COMPARISON: None
FINDINGS:
Air fills the stomach, small and large bowel, with a nonobstructive pattern.
There is a moderate amount of stool in the rectum. There is no evidence of
pneumoperitoneum. The lung bases are clear. Mild degenerative changes of the
lower lumbar spine are noted. Additionally aortic vascular calcifications are
noted.
IMPRESSION:
Moderate rectal stool burden. No evidence of obstruction.
|
10074282-RR-35 | 10,074,282 | 29,469,637 | RR | 35 | 2159-10-20 00:23:00 | 2159-10-20 01:34:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: ___ year old woman with failure to thrive, leukocytosis to 23,
tenderness to palpation at LLQ. // evidence of diverticulitis?
TECHNIQUE: Axial noncontrast CT images of the abdomen and pelvis were
obtained. Sagittal and coronal reformats were obtained.
DLP: 839 mGy-cm
COMPARISON: None.
FINDINGS:
There is a small pericardial effusion. Minor dependent atelectasis is noted.
Minor aortic valvular calcification is noted.
Assessment of the solid organs is limited without intravenous contrast.
Allowing for this there is no obvious hepatic lesion. No gallstones are
demonstrated. The gallbladder wall appears thickened. The spleen is normal
size. The pancreas is appears somewhat prominent. There is a 1.3 cm left
adrenal lesion measuring 8 Hounsfield units that is in keeping with a benign
adrenal adenoma. The kidneys are unremarkable, with no hydronephrosis.
There is no focally inflamed diverticulum identified. There is stranding along
the splenic flexure/descending colon with minor wall thickening noted. In
addition there is prominent edema in the small bowel mesentery most prominent
below the level of the pancreas.
There is no free fluid in the abdomen or pelvis. No fluid collection is
identified. No small or large bowel dilatation is present.
The bladder is unremarkable. There is atheromatous calcification involving the
abdominal aorta and iliac arteries. Multilevel degenerative/facet joint
changes are noted. 1cm sclerotic lesion is noted at T9 (602b,45). There is no
additional osseous lesion present.
Lipoma is seen along the left gluteus medius/rectus femoris muscles measuring
12 cm craniocaudal x 4.2 cm transverse x 6.5 cm AP.
IMPRESSION:
1. Extensive colonic diverticulosis, without inflamed diverticulum at present
time. Stranding along the splenic flexure/ descending colon with minor wall
thickening may reflect a subacute or chronic colitis, which may be on the
basis of extensive diverticular disease.
2. Edema throughout the small bowel mesentery, and thickening of the
gallbladder wall, likely reflecting third spacing in the absence of signs or
suspicion for pancreatitis. Correlation with albumin levels/fluid status is
advised.
3. Sclerotic lesion in the T9 vertebral body. In the absence of known primary
malignancy, or strong suspicion of malignancy this likely represents a bone
island.
|
10074282-RR-36 | 10,074,282 | 29,469,637 | RR | 36 | 2159-10-20 11:20:00 | 2159-10-20 13:20:00 | EXAMINATION: ABDOMEN US (COMPLETE STUDY)
INDICATION: ___ year old woman with leukocytosis, high transaminases,
abdominal pain, 78 lipase // eval for CBD dilatation vs. other process
TECHNIQUE: Grey scale ultrasound images of the abdomen were obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver is normal in size and the hepatic architecture is normal in
appearance. There is an echogenic lesion containing a central hypoechoic
region in the left lobe of the liver. This lesion measures 3.8 x 3.3 x 3.0
cm. A second hyperechoic lesion is seen centrally in the right lobe of the
liver measuring 2.2 x 1.2 x 1.7 cm. These lesions are consistent with
hemangiomas. No additional focal mass is identified in the liver. The main
portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is mild central intrahepatic biliary dilatation and the
extrahepatic common bile duct is dilated measuring 1.1 cm. No stones
identified within the common bile duct.
GALLBLADDER: Numerous small and larger (up to 1.5cm) gallstones are seen in
the gallbladder.
PANCREAS: The pancreas is unremarkable but is only minimally visualized due to
overlying bowel gas.
SPLEEN: The spleen is normal measuring 8.6 cm.
KIDNEYS: No hydronephrosis is seen in either kidney. The right kidney
measures 10.7 cm and the left kidney measures 10.2 cm.
RETROPERITONEUM: The aorta is obscured from view by bowel gas. The visualized
portion of the IVC is within normal limits.
IMPRESSION:
1. Mild central intrahepatic biliary ductal dilatation and enlarged common
bile duct. No stones are visualized within the CBD.
2. Cholelithiasis
3. Two hyperechoic lesions within the liver consistent with hemangiomas.
.
|
10074282-RR-37 | 10,074,282 | 29,469,637 | RR | 37 | 2159-10-21 14:02:00 | 2159-10-21 15:46:00 | INDICATION: ___ year old woman with new cough and wbc of 24 // Eval for pna
after fluid resuscitation
TECHNIQUE: Single frontal view of the chest
COMPARISON: ___
FINDINGS:
Low lung volumes. Cardiac size is top-normal . The lungs are grossly clear
there are minimal right lower atelectasis. The main pulmonary artery is
slightly enlarged. There is no pneumothorax or effusion
IMPRESSION:
No pulmonary edema
|
10074282-RR-38 | 10,074,282 | 29,469,637 | RR | 38 | 2159-10-22 15:45:00 | 2159-10-22 17:37:00 | INDICATION: Abdominal tenderness, elevated LFTs, and increasing leukocytosis.
COMPARISON: CT ___, ultrasound ___.
TECHNIQUE: MDCT axial images from the lung bases to the pubic symphysis were
displayed with 5-mm slice thickness with oral and intravenous contrast.
Coronal and sagittal reformations are displayed with 5-mm slice thickness.
DLP: 791.24 mGy-cm.
CT ABDOMEN: The visualized lung bases demonstrate a tiny left pleural
effusion with adjacent atelectasis. Trace pericardial fluid is seen. Aortic
valve calcifications are of unknown hemodynamic significance. Small hiatal
hernia.
A 4.0 x 2.8 cm hypodense lesion with peripheral nodular enhancement within
segment II of the liver (2:12) is compatible with hemangioma as seen on prior
ultrasound. A 1.4 cm hypodensity centrally within the right hepatic lobe has
been characterized on ultrasound as a hemangioma (2:13). A third lesion
peripherally in the left hepatic lobe (2:11) is most likely a hemangioma.
There is mild central intrahepatic bile duct dilation with extrahepatic bile
duct dilation to 11-mm but normal tapering at the level of the pancreatic
head. The gallbladder is not dilated. The spleen is unremarkable. Stranding
surrounding the pancreatic head is similar to ___. The bilateral
adrenal glands are normal. The kidneys enhance symmetrically and excrete
contrast promptly without hydronephrosis. Tiny hypodensities are seen within
the left kidney, some of which are too small to characterize and others of
which are simple cysts.
Numerous diverticula are seen throughout the large bowel. Stranding
surrounding the splenic flexure has slightly increased from ___. No
single inflamed diverticulum is identified. The appendix is visualized and is
normal. The abdominal aorta is of normal caliber throughout. The main portal
vein, splenic vein, and SMV are patent. No pathologically enlarged mesenteric
or retroperitoneal lymph nodes are identified. Mesenteric stranding is similar
to the prior study.
CT PELVIS: The rectum is normal. Diverticula are seen in the sigmoid colon
without inflammatory changes. The bladder and uterus are unremarkable. There
is no pelvic or inguinal lymphadenopathy. A lipoma is seen in the left rectus
femoris muscles with areas of stranding, but no nodular enhancement. A
sclerotic focus in the T9 vertebral body is unchanged and most likely reflects
a bone island in the absence of known malignancy.
IMPRESSION:
1. Stranding surrounding diverticula at the splenic flexure has slightly
increased from ___. Stranding at the pancreatic head and within the
mesentery is unchanged. It is unclear from imaging if this represents
diverticulosis with reactive stranding in the mesentery or pancreatitis with
reactive stranding in the left hemiabdomen, or two concurrent processes. No
abscess.
2. Lipoma in the left rectus femoris muscles with areas of stranding. Low
grade liposarcoma cannot be excluded.
|
10074282-RR-39 | 10,074,282 | 29,469,637 | RR | 39 | 2159-10-24 16:00:00 | 2159-10-24 16:37:00 | PA AND LATERAL CHEST, ___
COMPARISON: ___.
FINDINGS: Heart size and mediastinal contours are normal. Prominence of both
hila appear unchanged. Right lung and pleural surfaces are clear. Within the
left lung, there is a subtle opacity at the left base which is probably due to
a combination of a small pleural effusion and adjacent atelectasis as
demonstrated on recent CT abdomen of ___. No definite new areas of
consolidation are identified to suggest an infectious pneumonia. Mild
elevation of left hemidiaphragm is unchanged.
|
10074474-RR-12 | 10,074,474 | 26,500,750 | RR | 12 | 2165-11-02 17:12:00 | 2165-11-02 20:01:00 | INDICATION: ___ with neutropenic fever// pna
TECHNIQUE: Single portable view of the chest.
COMPARISON: None.
FINDINGS:
There is focal consolidation in the right suprahilar region. The lungs are
otherwise clear. The cardiomediastinal silhouette is within normal limits.
Right chest wall port catheter is seen to at least the level of the lower SVC
noting the tip is not definitively identified. No acute osseous
abnormalities.
IMPRESSION:
Right suprahilar opacity. Given patient's port, question of underlying
malignancy in this location. Alternatively, infection would be possible.
Correlation with prior imaging sh would be of use. Followup will be
necessary.
|
10074474-RR-13 | 10,074,474 | 26,500,750 | RR | 13 | 2165-11-02 19:38:00 | 2165-11-02 20:24:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with low platelets, neutropenic fever, delerium. Rule out
intracranial hemorrhage.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Total DLP: 2709.23 mGy cm
COMPARISON: Outside hospital CT head from ___.
FINDINGS:
The study is moderately limited due to patient motion despite repeat attempts
at scanning. Within this limitation, there is no evidence of large
intracranial hemorrhage, acute large territorial infarct, edema or mass. There
is prominence of the ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. Chronic deformity of the left maxilla
probably related to prior fractures as seen on imaging from ___. The
visualized portion of the paranasal sinuses, mastoid air cells, and middle ear
cavitiesare grossly clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
1. Moderately limited study due to patient motion.
2. No large intracranial hemorrhage, mass effect or acute large territorial
infarction.
|
10074474-RR-15 | 10,074,474 | 26,500,750 | RR | 15 | 2165-11-04 11:18:00 | 2165-11-04 13:44:00 | INDICATION: ___ year old male with neutropenic fever of unknown origin and
chronic left foot lestion// infection?
COMPARISON: None
IMPRESSION:
There is soft tissue swelling about the first MTP joint. There is soft tissue
calcification lateral to the first metatarsal head. There is slight bony
irregularity along the first metatarsal head medially and at the first
proximal phalangeal base. This is equivocal for osteomyelitis.Comparison two
old films if available would be helpful. Alternatively, MRI could also be
performed. Calcaneal spur is seen. There are mild degenerative changes of
the talonavicular joint and spurring of the talar head.
|
10074474-RR-16 | 10,074,474 | 26,500,750 | RR | 16 | 2165-11-04 12:36:00 | 2165-11-04 14:54:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ year old male with DLBCL on R-CHOP and neutropenic fever//
evaluation of perihilar opacities
TECHNIQUE: Multi detector helical scanning of the chest was reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. Contrast agent was not administered. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.3 s, 34.4 cm; CTDIvol = 6.0 mGy (Body) DLP = 203.2
mGy-cm.
Total DLP (Body) = 203 mGy-cm.
COMPARISON: No prior chest imaging is available.
FINDINGS:
A large collection of abnormal soft tissue infiltrates the right upper lateral
chest wall starting in the sub muscular plane at the level of the first rib
and extends into the lower axilla and right lower lateral chest wall
inferiorly to the level of the sixth rib laterally. At the thoracic inlet it
extends into the right supraclavicular station. Numerous left supraclavicular
and left upper axillary nodes are mildly enlarged.
The main to the chest wall is unremarkable. This study is not designed for
subdiaphragmatic evaluation but shows ascites. Small bilateral pleural
effusions layering dependently are not hemorrhagic. Minimal pericardial
effusion is physiologic.
A right transjugular central venous infusion port catheter ends in the right
atrium.
Lungs and airways:
A large densely consolidative mass like soft tissue abnormality in the
anterior segment of the right upper lobe marginating the prevascular
mediastinum, and anterior costal pleura to the level of the sternal angle
contains central low-attenuation material, 28 ___, suggesting necrosis.
Bronchial architecture is entirely subsumes medially but there are preserved
bronchi at the lateral margin of lesion which is quite irregular and has a
ground-glass halo and severely thickened septal architecture.
It is difficult to say where this lesion arose without looking at pre
treatment imaging, in attempt to determine whether it is a lung or pleural
lesion. Less likely it started in mediastinum.
Aside from to subcentimeter left upper lobe nodules, left upper lung is clear.
In both lungs there is thick subpleural atelectasis in the dependent lower
lobes.
Thoracic lymph nodes:
Right upper lobe bronchus is distorted and angulated as it deploys around
adenopathy in the right hilus and right lower paratracheal station toward the
large mass.
Cm size lymph nodes in the lower paratracheal, subcarinal, and paraesophageal
mediastinal stations are not necessarily enlarged.
Chest cage:
Although there are no bone lesions in the imaged chest cage suspicious for
malignancy or infection, it should be noted that radionuclide bone and FDG PET
scanning are more sensitive in detecting early osseous pathology than chest CT
scanning.
IMPRESSION:
Large, partially necrotic mass like lesion, anterior segment right upper lobe
has features which suggest treated primary tumorand needs to be compared with
pretreatment imaging to assess the real change. If this is not the primary
lymphoma, or the lymphoma involuted substantially, then the lung lesion is a
necrotizing pneumonia.
Right hilar and right lower paratracheal lymph nodes are enlarged. Several
other mediastinal lymph nodes are top-normal size.
|
10074556-RR-32 | 10,074,556 | 24,049,696 | RR | 32 | 2128-10-01 07:01:00 | 2128-10-01 11:53:00 | EXAMINATION: CT CHEST W/CONTRAST
INDICATION: ___ year old man with multiple masses seen in mediastinum on upper
cuts of recent MRCP. Largest lesion is 9cm. Apparent invasion of sternum,
chest wall and possibly causing mass effect on right atrium. Needs further
evaluation.// Assess mediastinal masses seen on MRCP.
TECHNIQUE: Contrast enhanced multidetector CT performed of the entire volume
of the thorax with multi planar reformations and MIP reconstructions.
DOSE: Acquisition sequence: 1) Spiral Acquisition 4.6 s, 36.5 cm; CTDIvol =
13.8 mGy (Body) DLP = 504.1 mGy-cm. Total DLP (Body) = 504 mGy-cm.
COMPARISON: No prior chest imaging available for comparison
FINDINGS:
FINDINGS:
No suspicious thyroid lesions. Left supraclavicular lymph node measuring 18
mm diameter (2, 13). Left subpectoral lymph node (4, 66) measuring 12 mm in
diameter. Left internal mammary lymph node (4, 127) measuring 21 mm diameter.
Multiple enlarged left axillary lymph nodes the largest measuring 17 mm in
diameter (2, 25). This study was not tailored to evaluate the
subdiaphragmatic organs and reference is made to prior MRCP done ___.
Multiple large, necrotic soft tissue masses in the anterior mediastinum and
appears to infiltrate the pericardial space for example in the right anterior
mediastinum measuring 77 x 66 mm in the axial plane and in the left anterior
costal phrenic angle measuring 76 by 46 mm (2, 55). The left internal mammary
artery is lifted of the anterior chest wall and encased, but not significantly
compressed, by this mass (2, 33). This anterior mediastinal mass results in
mass effect on the SVC, right heart as well as left pulmonary artery with no
obvious infiltration, but this cannot be excluded with certainty. Small
associated pleural effusion measuring 12 mm in diameter adjacent to the
anterior aspect of the right ventricle. Associated bilateral hilar
adenopathy, for example on the right measuring 31 mm in diameter. The left
brachiocephalic vein is encased by this mass in the superior mediastinum and
suboptimally assessed on the current study. The pulmonary artery is not
dilated. No obvious filling defects to suggest pulmonary emboli. Compromise
of the left main pulmonary artery as well as left upper lobe pulmonary
branches. Attenuation of the left superior pulmonary vein. Mild prominence
of the bronchial arteries is most likely compensatory. No bony destruction.
Please note that CT is not sensitive to evaluate for early bony involvement.
Small left-sided pleural effusion and trace right-sided pleural effusion.
Predominantly solid nodule with surrounding ground-glass opacity in the medial
aspect of the left upper lobe (4, 52) measuring 26 x 20 mm. A few smaller
pulmonary nodules for example in the left upper lobe adjacent to the left
oblique fissure (4, 120, 134 closed and in the anterior aspect of the lingula
(4, 152) measuring 6 mm in diameter. 2 mm nodule in the right lung apex is
indeterminate (4, 38).
IMPRESSION:
Large necrotic, multilobulated anterior mediastinal mass/masses with suspected
pericardial invasion. Associated chest wall, hilar, axillary and
supraclavicular lymphadenopathy. The nodule in the left upper lobe is
concerning for pulmonary involvement of this neoplastic process. At the top
of my differential diagnosis consider lymphoma, other diagnostic
considerations include thymic carcinoma and less likely an immature germ cell
tumor or sarcomatous lesion.
After review of the MR images, there is apparent loss of the fascial plane
between the right pericardial mass and the right atrium which is concerning
for myocardial infiltration.
Correlation with histology advised. Left axillary lymph nodes would be
amenable to biopsy.
In the differential diagnosis for the pulmonary nodule consider a primary lung
malignancy (would be unlikely though) and infection.
|
10074556-RR-33 | 10,074,556 | 24,049,696 | RR | 33 | 2128-10-03 15:32:00 | 2128-10-03 17:08:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old man with anterior mediastinal mass presents and
PICC//r dl picc 48cm iv ping ___ Contact name: ping, ___: ___
TECHNIQUE: Single frontal view of the chest
COMPARISON: Multiple prior chest radiographs most recently ___.
Chest CT ___.
FINDINGS:
A right PICC terminates in the low SVC. Predominantly anterior mediastinal
mass extending to the upper abdomen the well as the left upper lobe lung mass
are better evaluated on chest CT from ___. Small left pleural
effusion is present. There is no pneumothorax.
IMPRESSION:
1. Right PICC terminates in the low SVC.
2. Predominantly anterior mediastinal mass extending to the upper abdomen and
left upper lobe lung mass are better evaluated on chest CT from ___.
|
10074556-RR-34 | 10,074,556 | 24,049,696 | RR | 34 | 2128-10-04 11:46:00 | 2128-10-04 14:12:00 | EXAMINATION: CT abdomen/pelvis
INDICATION: ___ year old man with now known mediastinal lymphoma,
classification pending presented with weight loss.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.7 s, 30.4 cm; CTDIvol = 6.8 mGy (Body) DLP = 201.3
mGy-cm.
2) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
3) Stationary Acquisition 3.0 s, 0.2 cm; CTDIvol = 51.2 mGy (Body) DLP =
10.2 mGy-cm.
4) Spiral Acquisition 8.3 s, 53.9 cm; CTDIvol = 7.8 mGy (Body) DLP = 413.4
mGy-cm.
5) Spiral Acquisition 4.5 s, 28.9 cm; CTDIvol = 6.8 mGy (Body) DLP = 192.2
mGy-cm.
Total DLP (Body) = 819 mGy-cm.
COMPARISON: ___ chest CT
___ MRCP
FINDINGS:
LOWER CHEST: Multiple mediastinal/pericardial masses are not appreciably
changed compared to the MRI obtained less than 1 week prior. The largest mass
measures 8.9 x 7.1 cm, demonstrates central hypoattenuation compatible with
necrosis, exerts mass effect on the right atrium, and may invade the adjacent
myocardium (series 6, image 4). A mass adjacent to the cardiac apex measures
8.1 x 4.2 cm (series 6, image 11). A mass near the midline cardiophrenic
angle measures 4.6 x 2.2 cm (series 6, image 11). For a complete description
of the intrathoracic findings, please see the chest CT obtained 3 days prior.
ABDOMEN:
HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A
hypoattenuating lesion in hepatic segment II/segment III measuring 1.3 x 0.7
cm is unchanged and better characterized as a hemangioma on recent MRCP
(series 6, image 20). A hypoattenuating lesion in the posterior aspect of
hepatic segment VII is also better characterized on recent MRCP as a
hemangioma. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is surgically absent.
PANCREAS: The pancreas is normal attenuation throughout. A cystic lesion
along the inferior aspect of the pancreatic body/tail is better evaluated on
recent MRCP, but measures up to at least 1.5 cm (series 6, image 36).
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Small hypoattenuating lesions correspond to cysts on recent MRCP. No
suspicious renal lesion. No hydronephrosis. No perinephric abnormality.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is not visualized.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The prostate gland is mildly enlarged.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Unchanged mediastinal masses, the largest of which continues to exert mass
effect on the right atrium and may invade the myocardium.
2. No evidence of malignancy within the abdomen or pelvis.
3. A possible small pancreatic pseudocyst abutting the inferior aspect of the
pancreatic body/tail is better evaluated on recent MRCP.
|
10074556-RR-45 | 10,074,556 | 23,864,934 | RR | 45 | 2129-04-09 00:18:00 | 2129-04-09 02:08:00 | EXAMINATION: Chest radiographs
INDICATION: ___ with infectious work-up.
TECHNIQUE: Frontal and lateral views of the chest
COMPARISON: Chest radiographs between ___ and ___
FINDINGS:
Lungs are fully expanded and clear. No pleural abnormalities. Heart size is
normal. Cardiomediastinal and hilar silhouettes are unremarkable - extensive
mediastinal lymphadenopathy previously seen on CT is not appreciated. A dual
lumen right IJ central venous Port-A-Cath tip projects over the right atrium.
IMPRESSION:
No evidence of an acute cardiopulmonary abnormality.
|
10074908-RR-52 | 10,074,908 | 29,170,411 | RR | 52 | 2165-01-09 17:08:00 | 2165-01-09 18:13:00 | EXAMINATION: CT NECK W/CONTRAST (EG:PAROTIDS) Q22 CT NECK
INDICATION: History: ___ with mandibular pain/swelling // eval for abscess
TECHNIQUE: MDCT acquired helical axial images were obtained from the thoracic
inlet through the skull base following the intravenous administration of
contrast.
Coronal and sagittal multiplanar reformats were then produced and reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 3.0 s, 23.6 cm; CTDIvol = 5.8 mGy (Body) DLP = 135.8
mGy-cm.
Total DLP (Body) = 136 mGy-cm.
COMPARISON: ___ noncontrast head CT
FINDINGS:
Centered within the left parapharyngeal space at the level of the angle of the
mandible is an ill-defined hypodense region measuring approximately 1.4 x 1.0
x 0.9 cm with several foci of gas and vague peripheral enhancement compatible
with phlegmon and early abscess formation (602:38, 02:38). There is extensive
surrounding inflammation with soft tissue stranding, enlargement of the left
medial pterygoid muscle, and asymmetric enlargement of the left submandibular
gland with adjacent stranding. Multiple prominent left submandibular lymph
nodes are also noted along with thickening of the left platysma muscle.
Mass effect from the inflammation in the left parapharyngeal space results in
the oropharynx being slightly displaced to the right.
The parotid glands enhance normally and are without mass or adjacent fat
stranding. Scattered hypodense thyroid nodules are seen bilaterally measuring
up to 6 mm on the right. Apart from the prominent left submandibular lymph
nodes, no pathologically enlarged cervical lymph nodes are otherwise seen. The
neck vessels are patent.
The imaged portion of the lung apices are clear and there are no concerning
pulmonary nodules. As seen previously, numerous periapical lucencies are seen
within the maxillary and mandibular teeth bilaterally, but these do not appear
adjacent to the area of phlegmon/early abscess. There are no acute osseous
lesions. Mild to moderate degenerative changes are noted in the cervical
spine with mild central canal narrowing at C5-6. Imaged lung apices are
clear. The ostium is noted within a right ethmoid air cell. Mild mucosal
thickening is seen within the left maxillary sinus.
3.2 x 2.8 cm calcified right posterior fossa extra axial mass is unchanged and
compatible with a meningioma.
IMPRESSION:
1. 1.4 x 1.0 x 0.9 cm hypodense area within the left parapharyngeal space at
the level of the angle of the mandible containing foci of gas with peripheral
enhancement and extensive adjacent inflammatory changes most compatible with
phlegmon and early abscess formation.
2. Re- demonstration of extensive periapical lucencies within maxillary and
mandibular teeth bilaterally, likely reflective of periodontal disease, but
these are not adjacent to the area of phlegmon/ early abscess.
3. 3.2 cm calcified right posterior fossa mass is unchanged, consistent with a
meningioma.
|
10074908-RR-54 | 10,074,908 | 29,170,411 | RR | 54 | 2165-01-09 23:11:00 | 2165-01-10 10:30:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with Submandibular abscess // ETT and NGT
placement ETT and NGT placement
IMPRESSION:
Compared to chest radiographs ___.
New endotracheal tube ends less than 2 cm from the carina and could be
withdrawn 15 mm to reposition in standard placement.
Lungs grossly clear. Heart size normal. Esophageal drainage catheter passes
into the stomach and out of view. An identified catheter, perhaps a
ventriculoperitoneal shunt, traverses the right neck chest and upper abdomen,
also passing of view.
|
10074908-RR-56 | 10,074,908 | 29,170,411 | RR | 56 | 2165-01-10 01:19:00 | 2165-01-10 10:41:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: This is a ___ year old female with DMII, dementia, ___,
with 2 days of left submandibular swelling and pain, decreased PO intake. //
evaluate ETT placement evaluate ETT placement
IMPRESSION:
Compared to chest radiograph ___ and ___.
ET tube indwelling he ET tube tip less than a cm from carina should be
withdrawn 2 or 3 cm. Lungs fully expanded and clear. Normal
cardiomediastinal and hilar silhouettes and pleural surfaces. Nasogastric
tube passes into the stomach and out of view.
|
10074908-RR-57 | 10,074,908 | 29,170,411 | RR | 57 | 2165-01-10 09:58:00 | 2165-01-10 11:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with history fo ETT manipulation // ET
placement ET placement
IMPRESSION:
Compared to chest radiographs since ___, most recently ___ at
01:18.
Endotracheal tube has been repositioned, now in standard placement. Lungs
clear. Cardiomediastinal and hilar silhouettes and pleural surfaces normal.
Transesophageal drainage tube passes into the nondistended stomach and out of
view.
|
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